This questionnaire is intended as a self-assessment to help determine if you may have a low thyroid.

Hypothyroidism, or underactive thyroid, causes a deficiency of thyroid hormones that can affect virtually every cell and function in your body. Some of the signs to looks for include fatigue, frequently feeling cold, dry skin, depression, muscle and joint weakness and/or stiffness, constipation, and weight gain. If you are experiencing some of these signs you may have a low thyroid that warrants changes in your dietary nutrition and possibly a visit to your doctor for a thyroid blood test screening.

The American Thyroid Association estimates that 20 million Americans currently have some form of hypothyroidism, and up to 60% of them have not been diagnosed and are unaware they have it. That’s why it’s important to be aware of the signs to watch out for, and to make sure you’re getting the proper nutrition required for optimum thyroid health.

Instructions:  Score one point for each of the following questions you answer “yes” to. After answering all of the questions, to get your total score, add up all the points for your “yes” answers, and read the section below titled “Understanding Your Score.”

1. _____ Do you often feel fatigued?
2. _____ Do you have elevated cholesterol levels?
3. _____ Do you have difficulty losing weight?
4. _____ Do you frequently have cold hands and feet?
5. _____ Are you sensitive to the cold?
6. _____ Do you have slower thinking or “brain fog?”
7. _____ Do you find it difficult to concentrate?
8. _____ Do you have poor short-term memory?
9. _____ Do you often feel depressed?
10. _____ Do you have thinning hair or increased hair loss on your head, eyebrows, eyelashes, and body?
11. _____ Do you have less than one bowel movement a day?
12. _____ Do you have dry skin?
13. _____ Does your skin itch in the winter?
14. _____ Do you have fluid retention?
15. _____ Do you have recurrent headaches?
16. _____ Do you have restless sleep?
17. _____ Are you tired when you awaken?
18. _____ Do you have sleep apnea?
19. _____ Do you have afternoon fatigue?
20. _____ Do you experience tingling or numbness in your hands or feet?
21. _____ Do you have decreased sweating?
22. _____ Do your muscles ache?
23. _____ Do you have joint pain?
24. _____ Is your tongue enlarged with teeth indentations?
25. _____ Is your skin pasty, puffy or pale?
26. _____ Is your voice hoarse?
27. _____ Does your body temperature run below the normal 98.6º F.?

          _____ Total Score (To get your total score, add one point for each of the above questions you answered “yes” to.)

Understanding Your Score: 

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE.  It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment.