Please place a checkmark by the statements that apply to you:

(NOTE: This questionnaire is not a substitute for formal diagnosis by a medical professional)

I feel more fatigued or exhausted than expected or normal.

I am sleeping more than usual, or I often wake up feeling unrefreshed.

I have gained weight unexpectedly or am unable to lose weight despite diet & exercise.

My mood is often depressed, anxious or irritable.

I don't have a bowel movement every day, or my stools are difficult to pass.

My skin is dry, thick, or itchy, or I need daily lotion to prevent this.

My nails are brittle, dry or crack/break easily.

I am experiencing a low sex drive without a clear cause.

My eyes feel dry or seem extra sensitive to light.

I have thinning of the lateral side of my eyebrows.

My face (eyes, eyelids, etc.) have become puffier.

I have a hoarse voice, difficulty swallowing, or a feeling of fullness in my throat.

I have difficulty concentrating, remembering, or making decisions (“brain fog”).

My muscles and joints frequently ache.

I have tendonitis, plantar fasciitis, or carpel tunnel syndrome.

My body temperature is typically lower than 98.2F°.

I frequently feel cold when others do not, or my hands & feet often feel cold.

I have a personal or family history of autoimmune or thyroid disease.

My total or LDL cholesterol is high.

My TSH is greater than 2.5 (or >1.5 if I am already taking thyroid medication).

Females: I have a history of infertility or miscarriage.

Females: My menstrual cycles are longer, heavier, or more frequent than expected.