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A short-term, seven-day worksheet for recording symptom ratings, daily context and personal reflections.
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This printable provides one place to record how selected symptoms felt from day to day and note useful context you may want to remember.
It does not calculate a total symptom score or determine whether a symptom was caused by hypothyroidism.
Rate the following from 0 to 5 for each day:
Record:
Use the open writing areas for:
Write the date for each day and use one number from 0 to 5 for each symptom you choose to record. Try to use the numbers consistently across the week.
Add context only where it helps you remember what else was happening. At the end of the seven days, use the reflection space to summarize anything you noticed or want to discuss.
You do not need to complete every field, and you can stop if daily symptom monitoring feels stressful.
Use the matching online tool to enter the same symptom and context fields. Your current copy stays on your device and can be printed or saved as a PDF.
No. It records personal observations and cannot diagnose a condition or identify the cause of a symptom.
No. The worksheet is not a validated clinical scale and does not create an overall thyroid score.
No. Complete only the fields that are useful to you.
Yes. You can download and print another blank copy whenever you want to record a different seven-day period.
Free for personal, non-commercial use. Please do not resell or redistribute the files.
This printable may contain personal health information after you complete it. Store printed copies where you are comfortable keeping them and share them only with people you choose.
Join the Hypothyroidism Advice & Support Group, an active Facebook community with more than 11k members.
A printable can help organize the details. It may not capture how much effort an ordinary day can take. Mary Taylor says fatigue made work and family life harder. A chance conversation later led her to explore a four-week lifestyle guide focused on familiar food and household choices. Read what surprised her.
For personal organization only. This worksheet is not medical advice, a diagnostic tool or a substitute for care from a qualified healthcare professional.