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THYROID SURVEY MELBOURNE

by | May 15, 2023 | Body

THYROID SURVEY – Do you suffer from any of the following?

Please Rate your symptoms below in Numbers only, in a scale of 0, 1, 2 or 3

( 0= None,  1= Mild,   2= Moderate,   3= Severe  OR  if indicated  Yes =1 and No = 0)

THYROID SURVEY

Thyroid

  •   _____ Tiredness & Sluggishness, lethargic
  •   _____ Dryer Hair or Skin (Thick,dry,scaly)
  •   _____ Sleep More Than Usual
  •   _____ Weaker Muscles
  •   _____ Constant Feeling of cold (finger / hands/ feet)
  •   _____ Frequent Muscle Cramps
  •   _____ Poorer Memory
  •   _____ More Depressed (mood Change easily)
  •   _____ Slower Thinking
  •   _____ Puffier Eyes
  •   _____ Difficulty with Math
  •   _____ Hoarser or Deeper Voice
  •   _____ Constipation
  •   _____ Coarse Hair / Hair loss / brittle
  •   _____ Muscle / Joint Pain
  •   _____ Low Sex Drive / Impotence
  •   _____ Puffy Hands and Feet
  •   _____ Unsteady Gait (bump into things)
  •   _____ Gain Weight Easy
  •   _____ Outer Third Of Eyebrows Thin
  •   _____ Menses More Irregular ( should be 28 Days)
  •   _____ Heavier Menses   (clotting / 3+ days)
  •   _____ Carpel Tunnel Syndrome 

          _______   Total HYPO Score (8)

  •   _____ Palpitations  (Skipping of heart beat)
  •   _____ Insomnia
  •   _____ Tachycardia (Rapid or irregular heart beat)
  •   _____ Shakiness
  •   _____ Increased Sweating
  •   _____ Brittle Nails
  •   _____Loss of Appetite

            _______   Total HYPER Score (0)

DHEA  

  •   ______Constantly exhausted & tired
  •   ______Cannot tolerate noise
  •   ______My Libido is low
  •   ______Muscles are getting flabby (Loosing muscle tone)

________Total  DHEA  (2)

 

 Adrenals (Cortisol)

  •   ____Rapid heart beat
  •   ____I’m stressed out
  •   ____Have eczema, psoriasis, skin allergies, rashes
  •   ____Digestive problems
  •   ____Easily confused
  •   ____Wake up tired  (The following 6xQ’s are: Y=1, N=0↓ )
  •   ____Wake up full of energy Y/N
  •   ____2 to 4 pm feel tired, seek snack/Tea/Coffee/Coke Y/N
  •   ____Fall asleep in front of TV/reading/computer (before bed)Y/N
  •   ____As soon as I go to bed-Drop straight to sleep Y/N
  •   ____Need to read/TV -10 to 15 mins to drift into sleep Y/N  

            ________Total Adrenal (3)  

Iodine/Iodide 

  •   _____Fibrocystic Breast / lumps/ ovarian cysts
  •   _____Goiter Bulge or Band Around the Neck
  •   _____Slow Speech
  •   _____Enlarged tongue  
  •   _____Puffy Face /Puffy Hands

          ________Total   Iodine/Iodide Symptoms  (0)   

  •   _____Do you use salt with Iodine added    Y=1   N=0
  •   _____Number of days per week you eat seafood/shellfish**(Excludes Salmon/Canned   Tuna/Tilapia/Trout/Fresh water fish)

            ________Total Iodine Intake (6)

Melatonin, Serotonin, Tryptophan 

  •   _____Upon waking feel tired
  •   _____Wake up during the night
  •   _____If awakening,( in middle of night),cannot get back to sleep
  •   _____Trouble falling asleep
  •   _____Use a sleep aid, or drink Alcohol to relax
  •   _____My mind  is busy when I want to sleep 

        _______Total   Melatonin (2)

ACTH 

  •   _____Do you lack willpower & energy Y=1,   N=0
  •   ____Patches of hair loss    Y=1,   N=0
  •   ____Pale complexion/sunburn easily     Y=1,   N=0
  •   _____Often have Memory Loss  Y=1, N=0

           ________Total ACTH (2)

 

Your scores should be under the “total” number listed at the bottom of each section.

Book HERE if you need help to get your hormones sorted and feel great again. 

Otherwise contact me at juliesmethurst.info@gmail.com with any queries or questions.