Please consider each question carefully and check only those that pertain to
you.
|
Sign or Symptom
|
|
Chronically tired, fatigued or sluggish.
|
|
If I sit down during the day I suddenly get tired (energy drops
when I stop moving.)
|
|
I rely on caffeine, nicotine, or some other stimulant to keep my
energy going.
|
|
I have elevated cholesterol levels.
|
|
I am overweight by at least 10 pounds
|
|
I gain weight easily and I have difficulty losing weight.
|
|
I tend to have cold hands and feet.
|
|
I am sensitive to cold.
|
|
My head feels heavy or "foggy".
|
|
I have difficulty thinking.
|
|
I find it hard to concentrate - short attention span.
|
|
My memory is declining - poor short-term memory.
|
|
I am depressed, easily prone to depression, and/or I feel less
communicative or withdrawn.
|
|
I am prone to depression in the fall or spring.
|
|
I am experiencing hair loss - the hair on my head is falling out
|
|
I have less hair on my body than I used to. Ex: head, legs, arms,
eyelids, genitals.
|
|
I am prone to constipation (including having to strain to
eliminate). I have less than 1 bowel movement per day.
|
|
I have dry skin.
|
|
My skin often looks pasty, puffy or pale.
|
|
I have itchy skin during the winter.
|
|
I have rough patches of dry skin on my elbows.
|
|
My hair is dry and/or discolored.
|
|
I experience fluid retention.
|
|
My face, hands and feet often get "puffy".
|
|
I have recurrent headaches.
|
|
I often wake up with headaches or a "heavy" head that wears off
as the day progresses.
|
|
I sleep restlessly - insomnia.
|
|
I don't feel rested in the morning - still feel tired.
|
|
I need to sleep a lot, but still don't feel well rested.
|
|
I have sleep apnoea
|
|
My energy significantly drops in the afternoon - afternoon fatigue.
|
|
I often experience tingling or numbness in my hands or feet
(extremeties) or I have Carpel Tunnel Syndrome.
|
|
I don't sweat as easily as I used to even after exercising.
|
|
I have had problems with infertility or had miscarriages.
|
|
I get recurrent infections.
|
|
My muscles often ache or feel crampy.
|
|
I have general muscle weakness or my muscles tremble.
|
|
I often have joint pain.
|
|
The outer third part of my eyebrow is thinning or is gone.
|
|
My tongue is enlarged.
|
|
My voice has gotten hoarse or coarse.
|
|
I have a slow heart beat or low blood pressure.
|
|
My pulse is less than 60.
|
|
My average early morning body temperature is less than 36.6
Celcius. (*Click here to read about how to take your
temperature and here to read about what it means.)
|
|
Total Score (Give 1 point for each checkbox you checked):
|
|
|
|
|
Interpretation:
<11 unlikely you have low thyroid function
11-30 low thyroid function as a possibility
>30 low thyroid function is very likely
Click here to read general information about low thyroid function (hypothyroid) and
here to see more hypothroid symptoms.
Please Contact Us for more information or to setup an appointment.
|
