Hashimoto’s consultation

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Name *

First

Last

Date of birth *

Email *

Phone *

Address *

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City

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Postal Code

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Do you believe you have the mental capacity to make decisions about your own healthcare? *

We’re sorry, but there are no suitable treatments for you. Your symptoms indicate that your condition could be serious and you need to be seen by a doctor immediately. Please go to your local Accident and Emergency department.

The safety and well-being of our patients is our number one priority, and based on your answers, we can’t recommend any of our treatment options. We know this is both frustrating and disappointing, but we want to make sure that we’re putting your health first and that you find the right care.

If you’d like to speak to our clinicians about this, please email hello@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Have you been diagnosed with Hashimoto’s disease? *

If you’d like to speak to our clinicians about this, please email hello@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

How long have you been doagnosed with Hashimoto's disease? *

What medicine have you been prescribed for Hashimoto's disease? *

Do you have any other auto immune conditions? *

What other autoimmune condition do you have? *

Please tick all the symptoms you are experiencing *

Fatigue or feeling unusually tired
Weight gain despite no change in diet
Feeling cold or cold intolerance
Constipation
Dry, rough skin
Hair thinning or hair loss
Loss of the outer third of the eyebrows
Slow heart rate
Depression or low mood
Memory problems or difficulty concentrating (“brain fog”)
Puffy face or swelling, especially around the eyes
Muscle weakness or cramps
Joint pain or stiffness
Slow reflexes
Menstrual irregularities or heavy periods
Puffy or swollen thyroid gland (goitre)
Enlarged tongue
Puffy hands and feet
Slow speech or thinking

Are you experiencing any of the following symptoms in red? *

Unintentional weight loss
Persistent fever or night sweats
Shortness of breath or chest pain
New or severe headaches
Persistent or severe cough (especially with blood)
Swelling of legs, ankles, or feet
Palpitations or irregular heartbeat
Severe dizziness or fainting
Neurological symptoms (weakness, numbness, confusion)
Persistent vomiting or diarrhoea
Blood in urine, stool, or sputum
Enlarged lymph nodes or persistent/growing lumps
Severe joint pain or swelling
History of cancer or immunosuppression
Fatigue rapidly worsening or preventing daily activities
Unexplained bruising
Poor wound healing

If you’d like to speak to our clinicians about this, please email hello@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Have you used Low Dose Naltrexone (LDN) before? *

If you haven’t used low dose naltrexone (LDN) before, we advise to start with a lower dose and gradually increase until you find the maintenance dose that works for you. So, we usually recommend starting with the LDN oral solution and starting from 0.5ml daily and increasing the dose in 0.5ml increments. Alternatively you can start with a lower dose of the capsules. If you don’t find the dose you need listed, please contact us on hello@courierpharmacy.co.uk info@medicalmojo.co.uk or phone 0203 189 1942 and our compounding team can prepare the dose that’s right for you.

Did you experience any side effects when using LDN? *

Please explain what side effects you experienced *

Do you suffer from liver or kidney disease? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email hello@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Are you currently taking any opioid pain medication? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email hello@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you suffer from active substance abuse, either with alcohol or drugs? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email hello@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

I understand that:

LDN is an off-label, complementary treatment for Hashimoto’s disease and not a replacement for standard thyroid hormone therapy.
The evidence for LDN’s effectiveness in Hashimoto’s is limited and primarily based on anecdotal reports.
I will inform my healthcare provider of any side effects or concerns during treatment.
Regular monitoring and follow-up appointments are essential.
I have disclosed all relevant medical history and current medications.

LDN Consent *

I understand

What is your biological sex? *

Male
Female

Are you pregnant, breastfeeding, or trying for a baby? *

We’re sorry, but there are no suitable treatments for you.

If you’d like to speak to our clinicians about this, please email hello@courierpharmacy.co.uk. We’ll do our best to find a solution or recommend some safe next steps.

Note: If you made a mistake in your consultation, you can change your answers

Do you have any other medical conditions not already mentioned? *

Please provide more details *

Are you taking any other medications or do you have any other medical conditions that has not already mentioned? *

Please provide information about any medical conditions you have and the medications you’re currently taking. Include the medication name, dosage, and duration of use.

Other medication *

Do you have any other allergies that you have not previously mentioned? *

Please give us more details on these allergies *

Do you agree and consent to the following?

I am at least 18 years old and live in the UK.
I have the capacity to make decisions about your own healthcare
I shall be the sole user of any medication offered to me through this service.
I confirm all answers are provided by me and are truthful.
You understand the prescriber will take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health
If prescribed a treatment, I will read the Patient Information Leaflet (PIL) that will be provided.
If prescribed a treatment, I will inform my GP of my treatment and contact them if I have any side effects associated with the treatment.
You agree to our terms and conditions, privacy policy and acceptable use policy
You are aware you will be subject to a soft check to validate your identity using LexisNexis.

Checkboxes *

I agree to the statements and give my consent for any treatment provided.

Are you registered with a GP in the UK?

(Optional) Do you consent to us accessing your NHS Summary Care Record (the medical details held by your GP) or requesting further information on your medical history from your GP?

Summary care records

I consent

(Optional) Do you give us consent to write to your GP to share information of this supply and any information we hold about you?

Send information to GP

I consent

Product Category

Important

We review all orders to ensure you receive the best treatment possible. If what you ordered is unsuitable, we will refund part or all of your order.

If we decide that what you ordered is unsafe for you, based on the other information you provided, we won’t provide any treatments. However, we may call you and suggest alternatives.

Hashimoto’s consultation

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Conditions

Treatments

Care and policies