Bettalife4U - Printable Thyroid Questionnaire

Answer the following questions to determine if your health issues are related to thyroid problems. Answering yes to more than 9 is likely you have a low thyroid. The higher your score the more likely you have low thyroid. Send us your total score from this questionnaire.

experience hair loss or hair is coarse, dry, brittle?

have dry skin, or does your skin itch in winter?

experience decreased sweating?

have fluid retention?

get jumpy/tics in eyes, eyes sensitive to light, or gritty eyes?

get dizzy or have vertigo?

have tinnitus?

have a hoarse voice?

get recurrent headaches?

have thinning of eyebrows or eye lashes?

experience forgetfulness, or poor short term memory?

have elevated cholesterol?

have difficulty losing weight?

get cold hands and feet, or senstivity to cold?

have difficulty thinking, or experience brain fog?

have constipation (less than 1 bowel movement a day)?

feel moody, depressed, anxious?

have achey mucles/sore joints?

have low sex drive?

have history of infertility or miscarriages?

have irregular, or painful menstraul cycles?

experience more recurrent infections?

have a previous diagnosis of goitre/nodules?

have history of treatment for hypothyroidism?

have history of treatment for hyperthyroidism?

have a slow pulse?

have low blood pressure?

have sleep apnea?

sleep restlessly, or tired when you awake