9780738218670 (4)A PDF version of this checklist is available for you to print and bring to your doctor: Download the PDF now.


My risk factors for hyperthyroidism include:
____ I have a family history of thyroid disease.
____ I have had my thyroid “monitored” in the past to watch for changes.
____ I had a previous diagnosis of goiters/nodules.
____ I currently have a goiter/enlargement in my thyroid and/or thyroid nodules.
____ I was treated for hyperthyroidism in the past.
____ I had postpartum thyroiditis or hyperthyroidism during a previous pregnancy.
____ I had a temporary thyroiditis in the past.
____ I have a family history of autoimmune disease.
____ I have another autoimmune disease.
____ I am pregnant now, or I have had a baby in the past nine months.
____ I have a history of miscarriage.
____ I have had radioactive iodine in the past due to Graves’ disease/hyperthyroidism.
____ I have taken antithyroid drugs in the past due to Graves’ disease or a diagnosis of hyperthyroidism.


I have the following symptoms of hyperthyroidism:
____ My heart feels like it’s skipping a beat, racing, and I feel like I’m having heart palpitations.
____ My pulse is unusually fast.
____ My pulse, even when resting or in bed, is high.
____ My blood pressure is high.
____ My hands are shaking and/or I’m having hand tremors.
____ I feel hot when others feel cold; I am feeling inappropriately hot or overheated.
____ I am perspiring more or excessively.
____ I am losing weight inappropriately.
____ I am losing or maintaining weight but eating more.
____ I feel like I have a lot of nervous energy that I need to burn off.
____ I am having diarrhea or loose or more frequent bowel movements.
____ My eyes are dry/blurry vision/a noticeable “stare” or bulging eyeballs.
____ My skin looks or feels thinner.
____ My muscles feel weak, particularly the upper arms and thighs.
____ I am having difficulty getting to sleep, staying asleep, or going back to sleep after awakening in the middle of the night.
____ I feel fatigued, exhausted.
____ I have difficulty concentrating.
____ My hair is coarse and dry, breaking, brittle, falling out.
____ My skin is coarse, dry, scaly, thin.
____ I have a hoarse or gravelly voice.
____ I have pains, aches in joints, hands and feet.
____ I am having irregular menstrual cycles (shorter, less frequent, lighter, or not at all).
____ I am having trouble conceiving a baby.
____ I have had one or more miscarriages.
____ I feel depressed.
____ I feel restless, nervous, irritable, or anxious.
____ I experience panic attacks.

A PDF version of this checklist is available for you to print and bring to your doctor: Download the PDF now.

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