www.mdmazz.com - Hypothyroidism Clinical Questionaire

This is for instructional purposes only, see your doctor for a diagnosis!







 

HYPOTHYROIDISM

About Hypothyroidism

A deficiency of thyroid hormones can affect virtually all body functions.  The degree of severity of symptoms in adults range from mild and barely detectable to severe and very serious.  Symptoms of underactive thyroid include fatigue, especially on waking, feeling cold easily, dry skin, depression, muscle and joint weakness and stiffness, constipation, general slowness and possible weight gain.  

 

Blood tests such as TSH T3 T4 free T3,T4 and thyroid antibodies can help your doctor in the diagnosis of hypothroidism.  It is estimated that between 10-25 per cent of people suffer from some degree of hypothyroidism, many of whom are undiagnosed.

 

Self-assessment questionnaire

 

To see whether your thyroid may be underactive, complete the questionnaire below. The results of your test and how to interpret them will appear at the bottom of the questionnaire

   

 

Physical fatigue or lethargy          

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Energy is worse first thing 

  in morning, even after good sleep      

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Feel the cold more quickly 

  than most other people                 

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Hands and feet often cold              

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Bowel movements less than once 

  per day, or with difficulty            

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Dry skin or hair and/or hair loss     

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Difficulty losing weight, even 

  when eating less or exercising more    

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Do not sweat much, even 

  when exercising                              

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Memory is worse than it used to be     

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Poor concentration                    

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Depression                             

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Moody and irritable                    

  (Tick one only)

 

  rarely or never have the symptom-----------------

  tthe symptom is mild and/or only occasional------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Pre-menstrual syndrome                 

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Low sex drive                         

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

      

   Headaches, often worse in morning     

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Frequent infections 

  (e.g. throat or lung infections)       

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Eyelids are swollen and puffy           

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Bags under the eyes                      

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Face looks bloated                    

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Yellowing of palms of hands 

  and soles of feet                      

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Movements are on the slow side         

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Thinking is on the slow side           

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Eyebrows are thinning out              

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Joint stiffness and pain, 

  sometimes better after movement        

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Need a lot of sleep                    

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Feel worse if a meal is missed        

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Dizziness or poor sense of balance    

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

   Nasal congestion                       

  (Tick one only)

 

  rarely or never have the symptom-----------------

  the symptom is mild and/or only occasional-------

  the symptom is moderate and/or frequent----------

  the symptom is severe and/or almost constant-----

 

                                                  Your total is:



Interpreting your score(only instructive check with your doctor:

   

 0 - 9 

you are unlikely to be suffering from low thyroid function  

10 - 22

it is possible that your thyroid function may be low – you could carry out the Broda Barnes basal  metabolic temperature test described below for further information

23 - 39 

 it is quite likely that your thyroid function is low – do the Broda Barnes basal metabolic temperature test described below and talk to your Doctor  

40 or more

it is very likely your thyroid function is low – your Doctor will be able

to carry out a blood test. 

 

         

Broda Barnes Basal Metabolic Temperature Test  

 

Your thyroid gland affects metabolism in the body.  Metabolism is not simply how fast you burn food, but any chemical action in the body, from making hormones and enzymes, to digesting food and re-building cells.  All these actions create heat as a side-effect, just as a machine when it is worked becomes hot.  You can, therefore, estimate the efficiency of your  metabolism by taking your body temperature.

 

This is not a definitive test, but if you find your temperatures consistently low it would be advisable to visit your general medical doctor or if he advises an endocrinologist, who can also investigate other possibilities, such as adrenal exhaustion or underactive adrenal glands, pituitary gland deficiency, chronic fatigue syndrome or post-viral fatigue and anorexia.

  1. Shake down a traditional glass and mercury thermometer (not digital) to below 95oF (35oC) and place it by your bed before going to sleep at night.

  2. On waking, place the thermometer in your armpit for a full 10 minutes.  It is important to make as little movement as possible.  Lying and resting with your eyes closed is best.

  3. After 10 minutes, read and record the temperature accurately.

  4. Record the temperature for 3-4 days.

Menstruating women should perform the test on the second, third and fourth days of menstruation.  Men and postmenopausal women can perform the test at any time.

 

Your basal body temperature should be between 97.6F (36.4C) and 98.2F (36.7C).

Low basal body temperatures are quite common and may reflect hypothyroidism. 

 

High basal body temperatures (above 98.6F, 37.0C) are less common, but may indicate hyperthyroidism (overactive thyroid).  Common signs and symptoms of overactive thyroid include bulging eyeballs, fast pulse, hyperactivity, inability to gain weight, insomnia, irritability, menstrual problems and nervousness. -- www.mdmazz.com--