Hypothyroidism Questionnaire
The following is a list
of some of the signs & symptoms associated with
low thyroid. They
are not necessarily in order of importance. Mark the
ones that apply to you with a 3 for severe or constant,
2 for moderate or frequent, or 1 for mild or occasional
___
Fatigue: “born tired & never caught up”
___
Hair loss: not
only on the head but arms, legs & pubic areas
as well
___
Outer 1/3 of eyebrows missing
___
Skin: eczema
in infants; pimples & acne in puberty; dry flaky
skin as a teen or adult
___
Cracks in the skin of your heels (usually on the outer
edge radiating outward)
___
Childhood fatigue: are your children more tired than
they should be?
(Yes, low-thyroid affects most of
it’s victims from birth.)
___
Recurring childhood infections of all kinds, including
ear infections.
___
Did you have boils as a child?
___
Elevated cholesterol &/or triglycerides: atherosclerosis or clogged arteries is a primary
indicator of low
thyroid.
___
Heart disease or coronary artery disease: a side-effect
of low thyroid
___
Menstrual irregularity &/ or PMS
___
Chronic constipation
___
Low blood pressure in youth that may switch to high
BP after middle age
___
Fibromyalgia
___
Gallstones
___
Accumulation of tissue fluid (edema): feet & hands swell, baggy eyelids
___
Headaches, including migraine: can result from tissue edema
___
Anemia: low
body temperature inhibits red blood cell production
___
Tendency to be cold natured. Cold hands, cold feet.
___
Tendency to be overweight. Difficulty losing weight.
___
Slow pulse rate (except where blood pressure is very
low)
___
TOTAL: if you score 6 or more please consult
with us regarding possible need for
Thyroid hormone therapy
Measuring Thyroid Function
(Barnes’ Basal Temperature Test)
The
importance of the thyroid gland cannot be underestimated.
Its effect are profound throughout the body
To
measure your basal temperature you need either an
old style glass thermometer or a digital basal
thermometer. You can purchase a digital basal thermometer
at most any drug store for about 10 dollars.
Be sure it says “basal” on the package.
Some state that it will record temps for
oral, rectal & axillary (arm pit).
Basal
temperature refers to your basal metabolism which
must be measured at complete rest.
The best time for taking a basal temp is
just before getting out of bed in the morning.
Therefore, it is necessary to have your thermometer
at your bedside so you can just reach over and take
your temp. Although
oral temps are acceptable it is preferred to measure
the skin temperature somewhere on your trunk.
Generally I prefer the groin but if you are
snuggled up under the covers and your upper body
is nice & warm you can use the axilla (arm pit).
If not too much trouble or if you have a
digital thermometer I would ask that you provide
me with an oral and groin or axillary temp.
Be
sure not to get out of bed before taking the temp
not even to go to the bathroom.
But if you have been up within 30 minutes
of taking the temp be sure to note it on this page.
Label oral temps with an “O” and groin temps
with a “G”. If
you use a glass thermometer you must keep it in
place for 10 minutes by the clock. Digital thermometers require only about 30
seconds.
Record
your temps below:
1.________________ 2.________________ 3.________________
4.________________ 5.________________ 6.________________
Alliance Chiropractic Center
