Thyroid Function Assessment
Name
*
First Name
Last Name
Email
*
example@example.com
Thyroid Score
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Have you experienced unexpected weight changes (gain or loss)?
*
Rarely
Sometimes
Frequently
How often do you feel fatigued, even after a full night's sleep?
*
Rarely
Sometimes
Frequently
Do you experience mood swings, anxiety, or depression without a clear cause?
*
Rarely
Sometimes
Frequently
Are you often cold when others feel comfortable or excessively hot when others are fine?
*
Rarely
Sometimes
Frequently
Have you noticed changes in your skin, hair, or nails (thinning hair, dry skin, brittle nails)?
*
Rarely
Sometimes
Frequently
Do you experience irregular or heavy menstrual cycles (for women)?
*
No
Yes
Have you been experiencing muscle weakness or joint pain?
*
No
Sometimes
Frequently
Do you have trouble concentrating or often feel forgetful?
*
Rarely
Sometimes
Frequently
Have you been constipated, or do you have digestive issues like bloating or gas?
*
Rarely
Sometimes
Frequently
Have you noticed swelling in your neck or throat?
*
No
Yes
Do you feel your heart racing, or do you have an irregular heartbeat?
*
Rarely
Sometimes
Frequently
Do you experience frequent muscle cramps or stiffness?
*
Rarely
Sometimes
Frequently
How often do you feel more tired than usual, even after normal tasks?
*
Rarely
Sometimes
Frequently
Thyroid Score
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