Hypothyroid Self Assessment

For many people with an underactive thyroid (Hypothyroidism) taking thyroxine medication is a simple process of taking a standard and stable dose of pills every day for life. Providing you are well and stable we may be able to monitor your health without you visiting the practice.

If this applies to you (and you are not on any other tablets requiring monitoring), then before your medication runs out please complete this assessment and we will review whether we can repeat your medication for another 9-12 months.

Hypothyroid Self Assessment

Hypothyroid Self Assessment

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
Please let us know your preferred contact number in case we need to contact you.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.
Please state whether you are recording in Stones/Pounds/Kilos etc.
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? *
*