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This is a condensed version of the "Graves' Disease and Hyperthyroidism Risks, Signs and Symptoms Checklist." It can help you in getting diagnosed, and in managing your symptoms with your physician. The full checklist, which is 21 pages, can be found starting on page 61 of the book Living Well With Graves' Disease and Hyperthyroidism, by patient advocate and best-selling author Mary Shomon. The book is available at bookstores everywhere. Or go to on the web for more information, and links to purchase the book online.


Gender ___ Female Personal History ___ I have a past history of thyroid problems ___ I have a past history of autoimmune disease ___ I have a past history of endocrine disease Family History ___ I have a first-degree relative (parent, child, sibling) with Graves' disease or hyperthyroidism, another thyroid condition, or an autoimmune disease Age ___ I am between the ages of 20 and 40 Pregnancy ___ I am currently pregnant, or recently had a baby Smoking ___ I am a current or former smoker Excessive Intake of Thyroid Hormone ___ I am taking more thyroid hormone medication than has been prescribed ___ I am taking thyroid hormone medication that has not been prescribed to me by a doctor ___ I am taking over-the-counter energy, diet, thyroid support supplements ___ I am regularly eating meat that has been privately butchered from slaughtered farm animals or from hunting Continued on page 2


Exposure to or Excess of Iodine/Iodine Drugs ___ I recently had a medical procedure that used iodine contrast dye or a topical povidone/iodine ___ I take the heart drug Amiodarone ___ I take iodine supplements, or herbs that contain iodine, like kelp. Medical/Drug Treatments ___ I am currently or have recently been treated with Interferon Beta-1b, Interleukin-4, Immunosuppressant Therapy, antiretroviral treatments for AIDS, monoclonal antibody (Campath-1H) therapy for multiple sclerosis ___ I have recently received a donated organ or a bone marrow transplant ___ I am taking a drug known to cause or trigger hyperthyroidism Recent History of Hyperthyroidism-Inducing Conditions ___ I have recently been diagnosed with Struma Ovarii, Follicular Thyroid Cancer, ,Pituitary Adenoma, Molar Pregnancy, or Choriocarcinoma Nuclear Exposure ___ I lived near or was visiting the area near or downwind to the Chernobyl nuclear plant in the period on and after April 26, 1986 ___ I lived near or in the area downwind from the former nuclear weapons plant at Hanford in south central Washington state during the 1940s through 1960s ___ I live(d) near or work(ed) at a nuclear facility. Infection ___ I have, or recently had a viral infection ___ I have recently been diagnosed with Yersinia enterocolitica infection ___ I have recently consumed raw or undercooked poultry, unpasteurized milk and/or dairy products, seafood -- particularly oysters -- from potentially contaminated waters Trauma ___ I have recently had my thyroid or neck area injured, vigorously manipulated or palpated, surgery, biopsy on or injection to the thyroid, parathyroids, or the area surrounding the thyroid Allergies/Sensitivities ___ I have seasonal allergies, especially pollen and trees, food allergies, and/o gluten intolerance or celiac disease Toxic/Environmental Exposures ___ I frequently eat fish that contain higher levels of mercury--swordfish, shark, mackerel, and or tuna ___ I regularly use aspartame (i.e., Nutrasweet), eat foods or drink diet drinks that contain aspartame

Continued on page 3


Stress ___ I have experienced one or more of the high-stress events in the past year ___ I am left-handed ___ I am ambidextrous ___ I am prematurely gray-haired ___ I have one or more of the conditions associated with Type I Polyglandular Autoimmune Syndrome ___ I have one or more of the conditions associated with Type II Polyglandular Autoimmune Syndrome ___ I have recently been diagnosed with Clinical Depression ___ I have panic attacks, or have been diagnosed with Panic Disorder ___ I have recently been diagnosed as having a phobia ___ I have recently been diagnosed with Generalized Anxiety Disorder


Thyroid / Throat / Neck ___ I have a goiter, enlarged, painful or full-feeling neck and throat area ___ I can feel a lump in my neck, thyroid area, or lymph nodes ___ I have enlarged and/or tender lymph nodes ___ It's hard to swallow, my tongue feels thick Weight Changes / Appetite Changes ___ I feel unusually thirsty and/or hungry often ___ I am losing weight unexpectedly, or eating more and not gaining ___ I am losing weight or having excessive vomiting and nausea during pregnancy Temperature ___ I feel warm or hot when others are cold, or all the time, or I'm intolerant of heat, sweating excessively, or having hot flashes ___ I have a low-grade fever Heart ___ I feel like my heart is racing, pounding, palpitating, skipping beats ___ My pulse rate is high (insert beats per minute here ________ bpm) ___ I feel palpitations or flutters in my heart ___ I have frequent headaches ___ I often feel breathless, dizzy

Continued on page 4


Gastrointestinal System ___ I have more frequent or looser bowel movements ___ I have diarrhea ___ I have to urinate more frequently ___ I am experiencing nausea and/or vomiting ___ I am pregnant and vomiting excessively Energy / Muscles / Joints ___ I feel fatigued, exhausted, weak ___ My muscles, legs, arms, shoulders, joints are weak and or achy ___ I have had an unusual increase in energy and or need to exercise ___ I need very little sleep Skin ___ My skin is smoother, younger looking, and/or velvety ___ I have blister-like bumps on my forehead and/or face ___ My face, throat, palms and/or elbows have a flushed appearance ___ My skin is yellowish ___ I have waxy, reddish-brown lesions on my lower legs, feet, toes, arms, face, shoulders and/or trunk. Hair / Nails / Hands ___ I'm losing hair from my head ___ I'm losing body hair, or hair is thinner, finer, softer, won't hold a perm or curl ___ My hair has become thinner ___ My nails are shiny, weaker, or more brittle than usual ___ My fingertips and/or toes are swelling and becoming wider ___ My nail bed is separating from my finger Eyes ___ My eyeballs are bulging or protruding ___ I can't completely close my eye during sleep ___ My eyes feel uncomfortable, dry, gritty, sensitive, achy, twitchy ___ I frequently have a headache in the eye area ___ My eyes appear red, puffy or irritated ___ I have a noticeable "stare" or startled look ___ I have a wide-eyed, startled look ___ My vision is blurred or I have double vision Thinking/Cognition ___ I'm having difficult concentrating, remembering or making decisions ___ I'm feeling confused ___ I'm having difficult calculating or reading ___ My mind is always racing, I can't shut my thoughts off

Continued on page 5


Mood/Feelings ___ I feel sad, empty, hopeless, guilty, helpless ___ I've lost interest or pleasure in activities and hobbies, sex ___ I have thoughts of death or suicide ___ I have mood swings ___ I feel that sometimes I am behaving erratically or overemotionally ___ I inappropriately feel uncontrollable and/or irrational anger or aggressiveness at times ___ I feel anxious, nervous, restless, irritable, edgy, jumpy ___ I feel inexplicably frightened at times ___ I'm frequently worrying, and I find it hard to stop worrying ___ My reflexes are particularly fast, I'm "hyperactive," jiggling, have tremors or shaky hands ___ I'm having panic attacks Sleep Problems ___ I find it hard to fall asleep ___ After I've fallen asleep, I frequently wake up, and may have a hard time returning to sleep ___ When I wake up in the middle of the night, I find it hard to fall back asleep ___ I have insomnia and can't sleep, or wake feeling tired and unrefreshed Especially in Men ___ I have a low or reduced sex drive ___ I am having fertility problems ___ I have enlarged or tender breasts Especially in Women ___ I'm unable to get pregnant ___ I've had failed fertility treatments, a miscarriage or multiple miscarriages ___ My sex drive is low or non-existent ___ I have a suddenly "raging libido"/very high sex drive, ___ I'm behaving in a sexually obsessive way ___ My premenstrual syndrome (PMS) or menopause seems to have gotten worse ___ I'm 13 or older, and have not started menstruating ___ My menstrual periods have stopped, or become light, short, or less frequent Especially in Newborns/Babies ___ My newborn or infant was born prematurely , and/or had a low birthweight. ___ My newborn or infant has a smaller head in comparison to his/her body ___ My newborn or infant has a yellowish cast to the skin ___ My newborn or infant has a visible goiter, enlarged neck or prominent eyes ___ My newborn or infant has an elevated heart rate ___ My newborn or infant regularly runs a fever ___ My newborn or infant appears irritable, restless, hyperactive, anxious, unusually alert ___ My newborn or infant has frequent diarrhea and/or vomiting, is not gaining weight, or is losing weight Continued on page 6


Especially in Children ___ My child has a goiter and/or enlarged neck area ___ My child has had a recent sudden growth spurt ___ My child has developed an unusually large appetite ___ My child has had a period of rapid weight loss ___ My child has recently developed a poor handwriting ___ My child is experiencing poor school performance, or difficulty concentrating ___ My child is weak in the legs or arms ___ My child is often fatigued and exhausted ___ My child appears moody and lacking motivation ___ I worry that my child may be taking illegal drugs ___ My child has emotional outbursts, more temper tantrums, or is crying easily ___ My child is having trouble sleeping ___ My child is wetting the bed ___ My child is more irritable, or restless than usual ___ My child has tremors ___ My child can't sit still, and exhibits hyperactive movements, including leg swinging, finger tapping, etc. Especially in Teenagers ___ My teenager is moody ___ My teenager has an increased appetite ___ My teenager has had unexplained, rapid or sudden weight loss or is possibly anorexic ___ My teenager is suddenly gaining weight rapidly ___ My teenager is particularly nervous or anxious ___ My teenager's puberty is delayed ___ My teenager shows signs of muscle weakness Especially in the Elderly / Seniors ___ I feel withdrawn ___ I feel weak, confused, forgetful, or depressed ___ I am experiencing constipation ___ I'm experiencing more frequent falls and injuries ___ I'm experiencing more shaking. ___ I'm noticing more abnormal heart rhythms and palpitations

Continued on page 7



URGENT NOTE: If you have the following symptoms of this rare but potentially fatal condition, seek emergency medical treatment immediately.

Risks for Thyroid Storm ___ I have untreated Graves' disease and/or hyperthyroidism, or recently had thyroid treatment ___ I recently had an infection ___ I've had recent blood sugar changes ___ I recently had surgery on my thyroid ___ I have recently been under severe emotional stress ___ I have taken an overdose of thyroid hormone ___ I am experiencing or have been experiencing toxemia of pregnancy and labor Symptoms ___ I have a high fever of 100 to as high as 106 ___ My heart rate is high, even up to 200 beats per minute ___ I'm having heart palpitations ___ I'm feeling chest pain or shortness of breath ___ I'm experiencing confusion, delirium, psychosis or stupor ___ I feel extremely weak and fatigued ___ I feel extremely restless, nervous, having mood swings ___ My reflexes are exaggerated ___ I'm experiencing nausea, vomiting, and/or diarrhea ___ I've had a recent dramatic weight loss ___ I'm sweating profusely Living Well With Graves' Disease and Hyperthyroidism: What Your Doctor Doesn't Tell You...That You Need to Know, by Mary J. Shomon, Published Sept. 27, 2005 by HarperCollins, 448 pages, ISBN: 0060730196, List Price: $14.95

All information © Copyright Mary Shomon, 2005. You may link to this PDF file, and print a copy for your own use, but please do not re-post or reproduce.


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