Thyroid Quiz
In the past few weeks have you...
Felt fatigued
Yes
No
Had hair loss
Yes
No
Been constipated
Yes
No
Felt unusually cold
Yes
No
Had an excessive appetite
Yes
No
Had hearing problems
Yes
No
Had skin problems
Yes
No
Had nail problems
Yes
No
Had voice problems
Yes
No
Had difficulty swallowing
Yes
No
Had poor memory
Yes
No
Difficulty concentrating
Yes
No
Felt anxious for no reason
Yes
No
Wake up not feeling rested
Yes
No
Total
Scoring:
0-3 LOW, 4-7 MODERATE, 8+ SIGNIFICANT
Have you been clinically diagnosed with thyroid dysfunction? ie Hypothyroidism, Hyperthyroidism, Hashimoto's, Graves Disease
Currently on medication? Y/N? If Y, brand and dosage?
Name
First Name
Last Name
Email
example@example.com
Submit
Should be Empty: