Hypothyroid Self Test

1. ____ Fatigue

2. ____ Muscle aches and pains

3. ____ Joint pains

4. ____ Fibromyalgia

5. ____ Feelings of weakness

6. ____ Lethargy; loss of interest

7. ____ Memory loss

8. ____ Concentration difficulties

9. ____ Mental sluggishness

10. ____ Low moods

11. ____ Depression

12. ____ Cold hands and feet

13. ____ Sensitivity to cold

14. ____ Tendency toward constipation

15. ____ Weight gain

16. ____ Low blood sugar/hypoglycemia

17. _____ Menstrual problems

18. _____ Heavy bleeding during periods

19. _____ Repeated colds and flu

20. _____ Skin problems (itching, eczema, psoriasis, acne, or coarse, dry, scaly skin)

21. _____ Do not perspire easily

22. _____ Hoarse voice

23. _____ Feeling of fullness in neck

24. _____ Swelling of the eyelids

25. _____ Hair loss

26. _____ Dry, coarse hair

27. _____ Loss of outer 1/3 of eyebrows

28. _____ I have about as many mental and emotional symptoms as physical ones

_______ Total