Thyroid Mini-Test Name* First Last Email* Select all that apply: Lethargy or weakness All-around slow with sluggish metabolism Cold extremities Hair loss from outer third of eyebrows Swelling of tissues, especially around the eyes Short-term memory loss Feel like you can't get enough breath or oxygen Easily constipated Cholesterol runs high Lack of appetite Low libido Insomnia Apple-shaped body (upside down) Wear socks and even sweaters at night when going to bed Stiff joints and/or spine Abnormally low thyroid blood tests Mentally slow or depressed Weight gain on the front of the abdomen Diagnosed with thyroid cysts or adenoma (or goiter) None of these apply Do you lack half moons on all fingers except the thumb and fifth finger? Moderately Completely Don't know / does not apply Do you suffer from tendonitis, bursitis, or other ligament-tendon inflammation? Yes No Don't know / does not apply
