• Thyroid Assessment Questionnaire.

  •   No or Rarely 0 Sometimes 3 Often 5
    I am more moody than I used to be.
    I have chronic or recurring muscle/joint pain.
    I notice puffiness in my hands, feet or face.
    I’m gaining weight for no reason.
    I have or have had carpal tunnel syndrome or tendonitis.
    My sex drive is lower than it used to be.
    I have cold hands and feet.
    More than a few hairs fall out in the shower or on my hairbrush.
    I have a high level of stress in my life.
    My brain feels foggy, I’m forgetful, or am thinking more slowly.
    My hair is brittle and dry.
    My eyebrows are thinning, especially the outer third.
  •   No or Rarely 0 Sometimes 3 Often 5
    My skin is dry, thick, coarse or scaly.
    My skin is thin and fragile.
    I get constipated (less than one healthy bowel movement per day).
    I have high cholesterol.
    I get numbness or tingling in my hands or feet.
    I feel depressed often or my depression isn’t responding much to antidepressants.
    I have anxiety or panic attacks.
    I feel cold when others are comfortable.
    I get headaches.
    I can’t seem to lose weight despite good diet and exercise.

  • Just 5 more questions to answer....

  •   No or Rarely 0 Sometimes 3 Often 5
    I’m exhausted when I wake up, even after 8-10 hours of sleep.
    I’m unable to function all day without a nap.
    I have trouble falling asleep or staying asleep.
    I eat soy products regularly.
  •   No or Rarely 0 Sometimes 3 Often 5
    FOR WOMEN: I have menstrual irregularities, PMS or infertility.
    FOR MEN: I have erectile dysfunction or premature or delayed ejaculation.

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