Hashimoto's thyroiditis blocks young people who want to take the civil service exam

The medical examination standards for civil servants are increasingly being abused by more and more public institutions and large enterprises

"Hashimoto's thyroiditis" stops young people who want to take an examination of the public

Hashimoto's thyroiditis, a common autoimmune thyroid disease. The latest authoritative research data show that the prevalence of the disease in the female population is more than 10%.

In medical textbooks and physicians, this disease is a chronic disease that does not affect people's normal life and work. It only needs to use corresponding hormone drugs to control when there are obvious symptoms of hypothyroidism. However, in my country's "General Standards for Civil Servants Recruitment Physical Examination", it belongs to the list of "unqualified physical examination.

Zhang Baoyan, a deputy to the National People's Congress, has proposed to revise the standard for two consecutive years. Her research found that in addition to the recruitment of civil servants in China, the standard has been used by more and more industry units, resulting in many college students suffering from chronic diseases such as Hashimoto's thyroiditis unable to apply for jobs smoothly.

Chou, 24, is one of the "victims" of Hashimoto's thyroiditis. In June last year, she applied for the post of full-time social worker in Gongshu District of Hangzhou City. After passing the written examination and interview, she was found to be unqualified due to Hashimoto's thyroiditis in the physical examination, so she was not employed. And this job is not a civil servant or career establishment.

Xiao Zhou believed that this was employment discrimination, so he sued the Gongshu District Government and the Civil Affairs Bureau to confirm that the administrative act of the two defendants to conduct medical examinations on them was illegal. It is reported that the case has not yet been sentenced.

Don't understand:

Due to suffering from Hashimoto thyroiditis physical examination was "brush down"

On June 30, 2022, Xiao Zhou, who graduated from a university in Jiaxing, Zhejiang, applied for the post of full-time community worker in Xiangfu Street, Gongshu District, Hangzhou. "This post is neither a civil servant nor a public institution. My family also encouraged me to take the public examination, so I tried to be out of the staff first."

According to Xiao Zhou, after passing the qualification examination, she successfully passed the written examination and interview. On September 17 of the same year, under the leadership of Xiangfu Street staff, she went to Zhejiang Provincial People's Hospital for the first physical examination. "The surgeon initially judged that the thyroid gland was abnormal." On September 23, after reexamination of seven items of thyroid function and ultrasonic test, Xiaozhou's serum thyroglobulin antibody and thyroid peroxidase antibody were positive, concerning for Hashimoto's thyroiditis. The physical examination sheet shows that according to Article 16 of the "General Standards for Physical Examination for Civil Servants" issued by the Ministry of Human Resources and Social Security [2016], Xiao Zhou was identified as "unqualified in physical examination".

"The doctor who did B- ultrasound told me that the disease did not affect my work and life. As a result, I was informed by telephone from the street at the end of September that I was not qualified for the medical examination and would not be employed." Chou told Chengdu Business Daily-Red Star News reporter.

It is reported that according to article 16 of the standard, "three degrees of simple goiter, unqualified." At the same time, in the "Precautions" explained in the "Civil Servant Recruitment Physical Examination Operation Manual", Hashimoto's thyroiditis was clearly determined to be unqualified in the physical examination.

"But I went to other hospitals for examination. The doctor said that my thyroid function was normal and I didn't need to take medicine." Chou was puzzled by this.

The reporter found that the National Health and Family Planning Commission's standardized training program textbook "Internal Medicine-Endocrinology" published by the People's Health Publishing House in 2015 has a detailed explanation of Hashimoto's thyroiditis. According to the textbook, Hashimoto's thyroiditis is an organ-specific autoimmune disease caused by the interaction of genetic factors, autoimmune factors and environmental factors. More than 90% of Hashimoto's thyroiditis occurs in women, and it is more common in women of reproductive age.

The textbook also states that there is no treatment for the cause of the disease, and because of its slow development, many patients usually do not need treatment. "Treatment indications are mainly based on thyroid function status and the degree of goiter, including iodine restriction, follow-up, hormone therapy, and surgery."

After Xiao Zhou questioned the results of the physical examination, the staff of Xiangfu Street took him to Zhejiang Hospital for a second re-examination, and the results were also regrettable.

On October 14 of the same year, she received a street notice that she was not admitted to the post because of Hashimoto's thyroiditis.

Resonance:

Young man "stopped" by Hashimoto's thyroiditis

Xiao Zhou fell into depression because of this. After learning that Hashimoto's thyroiditis might be inherited, she thought that her mother had a "big neck", but she never took her mother to check, "for fear that she really had this disease, and then felt guilty because it was inherited to me."

Through the Internet, Xiao Zhou accidentally discovered that there are many patients who have similar experiences with her, including graduate students, medical students, and normal students from prestigious universities.

Xiaoqing, a graduate student from a 211 university in Fujian, was admitted to the teacher establishment in his hometown in 2021, but was found to have Hashimoto's thyroiditis in the physical examination and was not passed. Guangxi college student Ma passed the written examination interview of a public institution with excellent results when he graduated in 2021, and was also not employed after finding out Hashimoto's thyroid. Guangdong college students Hua, after graduation to participate in the "three branches and one support" work, at the same time, she participated in the unified recruitment examination for public institutions in Guangdong Province. After passing the written examination, she found Hashimoto's thyroiditis in the work physical examination. After finding that the physical examination of the recruitment unit was carried out in accordance with the physical examination standards for civil servants, she had no choice but to give up the interview.

Also give up, there are many graduating college students, graduate students. Because they found that not only the posts of civil servants, but also the posts of career and teachers, even the posts of counselors without establishment, state-owned enterprises and banks all refer to the physical examination standards of civil servants.

Zhang Baoyan, founder of the baby home search network and deputy to the 13th National People's Congress, once paid attention to the plight of this group. At the National Two Sessions in 2021 and 2022, she proposed to revise the physical examination standards for civil servants for two consecutive years. For some chronic diseases that do not require medication and can perform their duties normally, they should be qualified in the physical examination. For some patients with chronic diseases who can be controlled by drug treatment and can perform their duties normally, they should also be qualified for physical examination.

At the National Two Sessions in 2023, Ni Minjing, a member of the National Committee of the Chinese People's Political Consultative Conference, also submitted relevant proposals. Ni Minjing said that the current "standard" has been implemented for many years, and the employment discrimination caused by the physical examination standard is becoming more and more serious. It is urgent to revise the standard and protect the equal employment right of college students with chronic diseases. The overall prevalence of thyroid diseases in adults over 18 years old in China is as high as 50%, and the positive rate of thyroid autoantibodies is 14.19%. Ni Minjing suggested that some provisions in the standards, such as "polycystic kidney, unqualified" and "Hashimoto's thyroiditis, unqualified" should be canceled first.

expert

Asymptomatic patients with normal nail function

Symptoms are treated no differently from normal people.

According to a paper published in the journal Nature Communications by the research team of Song Huaidong, a professor in the Department of Endocrinology and Metabolism at the Ninth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine in early 2022, the prevalence of Hashimoto's thyroiditis in the female population exceeds 10%. "Especially with the widespread clinical application of thyroid autoimmune antibody determination, a large number of patients with early Hashimoto's thyroiditis have been diagnosed, but there is a lack of effective treatment to prevent thyroid tissue destruction and hypothyroidism." Song Huaidong said.

"But even if the peripheral blood thyroid hormone concentration of patients completely returns to normal after treatment, about 25% of patients still have symptoms of hypothyroidism." The paper wrote.

"Asymptomatic Hashimoto's thyroiditis has normal thyroid function and is essentially harmless. Even symptomatic Hashimoto's thyroiditis, treated with thyroxine to correct thyroid function, is no different from normal people." Famous thyroid medicine expert Teng Weiping said in reply to the reporter's email interview.

"From clinical experience, the incidence of Hashimoto's thyroiditis is very high. It is now common in women in their 20 s and even in their 18 s and 19 s." Dr. Zhao, chief physician of the Endocrinology Department of a tertiary hospital in Shanxi, told reporters that most of them are pure antibody positive, and the thyroid function is normal, and it has no effect on the body. The most serious consequence is hypothyroidism. Take euthyroxine. In extreme cases, lymphoma will be combined, but this situation is very rare."

Dr. Zhao was also puzzled by the standard's identification of Hashimoto's thyroiditis as an unqualified indicator for physical examination. "Our hospital is a designated hospital for physical examination. There was once a candidate who passed the written examination interview and found Hashimoto's thyroiditis in the physical examination. He refused to come to the hospital for reexamination. At that time, I also expressed my medical opinion to the recruitment unit, but it was not accepted."

"Personally, I think that the proposal to cancel" Hashimoto's thyroid gland, unqualified "requires rigorous research." Dr. Zhao said that it may need to be judged from the incidence rate, the results, the consumption of treatment costs, and the ability of candidates to work.

Thinking

Is it legal to expand the medical examination standard for civil servants?

After seeing what happened to his peers, Xiao Zhou, who was depressed for more than half a year, regained his confidence. "since there is little hope of changing the physical examination standards, we cannot allow the physical examination standards to be expanded at will."

After failing to apply for administrative reconsideration, in March 2023, she took the Gongshu District Government and the Gongshu District Civil Affairs Bureau to court. Xiao Zhou believes that the recruiter only based on the physical examination results for Hashimoto's thyroiditis, using the "standard" to determine that it does not meet the physical health standards required for the post of community workers, and that it does not have the physical conditions to apply for the post, which is a malicious discrimination against her and infringes on her equal employment right.

Xiao Zhou requested the court to confirm that the defendant Gongshu District Civil Affairs Bureau's specific administrative act of conducting a physical examination with the "Standard" was illegal, and ordered the Gongshu District Civil Affairs Bureau to correct the above-mentioned illegal acts and employ him in accordance with the law.

On May 24, 2023, the case was held in the first instance of Hangzhou Shangcheng District People's Court. The reporter was informed that Xiao Zhou's agent and lawyer Chang Boyang of Henan Golden Sunshine Law Firm pointed out in court that Xiao Zhou's application for a post is not a civil servant post, and the civil servant physical examination standards should not be applied to his physical examination. "The defendant said in court that there are no other standards that can be used at present, and only the physical examination standards for civil servants can be used. Without legal and factual basis, it is necessary to follow the principle of reasonable administration, do not carry out physical examination or formulate practical physical examination standards that can meet the requirements of social work positions, and cannot apply the physical examination standards for civil servants without legal authorization." Chang Boyang said.

Chang Boyang also held that the defendant's behavior violated the provisions of Article 25 of the Employment Promotion Law that "people's governments at all levels create a fair employment environment and eliminate employment discrimination" and the principle of reasonable administration.

Chang Boyang and another agent, Zhang Xiaoli, a lawyer at Hainan Haishi Law firm, believe that the "Standard" has been misused and abused by more and more public institutions and large enterprises, which has made it more and more difficult for groups like plaintiffs to find jobs. They are not only unable to take up civil service posts, but even non-civil service posts.

"No matter how highly educated they are and how good a university they graduated from, just because of such a disease that does not affect their work and life, they will not be able to get a job." Chang Boyang believes that this is not only an infringement of the rights of individuals and a group, but also not conducive to social development.

It is reported that the case has not yet been sentenced.