Thyroid Hormone Evaluation Are you taking thyroid medications but you still feel tired and can’t seem to lose weight? If you are unsure if you are hypothyroid, take our thyroid hormone evaluation to see if you may need additional support. Call (770) 635-7697 for immediate support. What statement best describes your energy levels? Check all that apply. l feel good for the best part of the morning but l feel really tired after eating lunch l am fatigued both in the morning and after lunch but seem to get feel more energized in the evening after dinner l wake up tired and feel exhausted all day l have lots of energy all the time Which of these signs and symptoms apply to you? Check all that apply. l am gaining weight for no clear reason or am unable to lose weight with a diet and exercise program My hands and feet are cold to the touch and l frequently feel cold when others do not l have been told l have high cholesterol My skin is rough, dry, scaly and itchy My hair rough, coarse dry, breaking, brittle and falling out My nails have been dry, and brittle, and break more easily My eyebrows appear to be thinning, particularly the outer portion My voice has become coarse and/or 'gravelly' l am constipated(less than 1 bowel movement a day) l am depressed, restless, moody, sad l have pain, aches, stiffness, or tingling in joints, muscles, hands and/or feet l have difficulty concentrating or remembering things l have a low sex drive My neck or throat feels full, with pressure, or larger than usual, and/or l have difficulty swallowing l have puffiness and swelling around the eyes, eyelids, face, hands and feet l am having trouble falling or staying asleep Women: l am having irregular menstrual cycles (longer or heavier or more frequent) l take thyroid medication and still have some or most of the symptoms above Which of these symptoms would you like see improvement with the most?Would you like to lose weight? Yes No Not sure Approximately how many pounds would you like to lose?Please enter a number from 1 to 700.Please provide any additional symptoms or health problems you would like to improve upon.Your First Name(Required)Please enter your first name. Your Last Name(Required)Please enter your last name. Your Phone Number(Required)Best number in which to contact you.Your Email Address(Required) CommentsThis field is for validation purposes and should be left unchanged. Δ
