View of Occurrence of Hashimoto thyroiditis among the first- and second-degree relatives of systemic lupus erythematosus patients with Hashimoto thyroiditis

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Reumatismo 4/2013 205

APPENDIX

Reumatismo, 2013; 65 (4): 205

APPENDIX

This questionnaire is aimed at evaluating the presence of a thyroid disease among your First and Second Degree relatives (parents, siblings, sons/daughter, grandparents, nephew)

1) Do you know if among your first or second-degree relatives, someone is suffering of thyroid diseases? If you have answered yes, please specify the type of relationship

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IF THE ANSWER IS NO, CONCLUDE THE QUESTIONNAIRE

2) Do you know what type of thyroid disease? Do you remember if he/she is suffering of hypo- or hyperthyroidism? If you do not remember, do you know if he/she is taking any treatments (Levothyroxine, Metimazole)?

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3) Do you remember if your first or second degree relative is suffering of HASHIMOTO THYROIDITIS?

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4) Do you remember if your first or second degree relative is suffering of GRAVES DISEASE (or Basedow)?

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5) Do you remember if your first or second degree relative is suffering of thyroid nodules?

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6) Do you remember if your first or second degree relative has been ever diagnosed with thyroid cancer?

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Non-commercial

Do you remember if your first or second degree relative is suffering of HASHIMOTO

Non-commercial

Do you remember if your first or second degree relative is suffering of HASHIMOTO __________________________________________________________________________

Non-commercial

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Non-commercial

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Non-commercial

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Do you remember if your first or second degree relative is suffering of GRAVES DISEASE

Non-commercial

Do you remember if your first or second degree relative is suffering of GRAVES DISEASE __________________________________________________________________________

Non-commercial

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Non-commercial

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use

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use

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use

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use

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only

you remember if he/she is suffering of hypo-

only

you remember if he/she is suffering of hypo- or hyperthyroidism? If you do not remember, do you know if he/she is taking any treatments

only

or hyperthyroidism? If you do not remember, do you know if he/she is taking any treatments __________________________________________________________________________

only

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