Symptoms of Hypothyroidism
Dr. Shabnam Das Kar, MD | drkarmd.com🔒 Your Privacy is Protected
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Patient Details
Symptom Questionnaire
Last 30 daysRate each symptom based on your experience over the last 30 days:
0
Never / Not present1–2
Mild — rarely noticed3–4
Moderate — occasionally interferes5–6
Significant — frequently present7–8
Severe — limits daily activities9–10
Extreme — severely debilitating
1
Fatigue or persistent tiredness
0 = Never10 = Extreme
2
Lack of energy or motivation
0 = Never10 = Extreme
3
Weight gain / difficulty losing weight
0 = Never10 = Extreme
4
Cold hands, feet, or general cold intolerance
0 = Never10 = Extreme
5
High cholesterol
0 = Never10 = Extreme
6
Slow heartbeat
0 = Never10 = Extreme
7
Shortness of breath on exertion
0 = Never10 = Extreme
8
Slow movements or slow speech
0 = Never10 = Extreme
9
Hoarseness of voice
0 = Never10 = Extreme
10
Puffy face or swelling around the eyes
0 = Never10 = Extreme
11
Dry or flaky skin
0 = Never10 = Extreme
12
Hair loss or thinning hair
0 = Never10 = Extreme
13
Constipation
0 = Never10 = Extreme
14
Muscle cramps
0 = Never10 = Extreme
15
Joint pain
0 = Never10 = Extreme
16
Generalised body stiffness
0 = Never10 = Extreme
17
Forgetfulness or memory problems
0 = Never10 = Extreme
18
Poor concentration or mental sluggishness
0 = Never10 = Extreme
19
Slow thinking / difficulty processing information
0 = Never10 = Extreme
20
Pins and needles sensation
0 = Never10 = Extreme
21
Lack of coordination (especially hands and feet)
0 = Never10 = Extreme
22
Ringing in the ears or reduced hearing
0 = Never10 = Extreme
23
Anxious feelings or nervousness
0 = Never10 = Extreme
24
Low mood or depression
0 = Never10 = Extreme
25
Loss of interest in usual activities
0 = Never10 = Extreme
26
Unrefreshing sleep or sleeping too much
0 = Never10 = Extreme
27
Difficulty waking in the morning
0 = Never10 = Extreme
28
Low sex drive
0 = Never10 = Extreme
29
Menstrual irregularities
0 = Never10 = Extreme
30
Infertility or recurrent pregnancy loss
0 = Never10 = Extreme
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