Hypothyroid Self Assessment
Who are you completing this form for?
For example, on behalf of a child or dependent
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you
If it is less than 60 or above 80 when resting please discuss this with your doctor
Change in Weight:
Have you had your blood tested for thyroid in the last 9 months?