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The Metabolic Scorecard™ , developed by Bruce Rind MD, is method for looking at symptoms to distinguish whether problems are adrenal, thyroid,  or a mixture of both. To understand an integrative & functional medicine approach to identifying and correcting low metabolic energy problems please refer to the Health Program Metabolic Therapy: Thyroid, Adrenal and Hormonal Correction.

Are you fatigued?
Trouble sleeping?
Gaining weight?
Can't focus?

The diagnosis for many of these symptoms is low metabolic energy, and the cause in many cases is either Adrenal Fatigue or Low Thyroid Function. Use the scorecard below to see how many of your symptoms are in each column. This will tell you if your condition is predominantly low function of thyroid, adrenals or a mixture of both. The more severe the problem, the greater number of symptoms will be present.


Signs and Symptoms: Adrenal Fatigue vs. Low Thyroid Function
Key: - generally absent; +possibly present; ++ often present;
+++ always or almost always present
Signs and Symptoms  Adrenal  Mixed (1)   Thyroid 
Body Type  Mild: Gains weight easily;
Moderate: Can't lose weight;
Severe: Thin, can't gain weight 
Gains easily,goes to tummy/hips first, very hard to lose  Weight gain, generalized or global, extremely hard to lose 
Face Shape  Eyes, cheeks sunken when severe  Normal  Full, puffy around eyes 
Eyebrows  Tend to be full  Normal to sparse  Very sparse outer 1/3 to 1/2 
Tissue Around eyes  Sunken appearance, may have dark circles  Normal or some "bags" under the eyes  Puffy around the eyes, often bags under the eyes 
Facial Coloring (2)  Tendency to pallor, especially around mouth. In dark skin, it darkens around mouth, forehead, sides of face  Pallor around mouth (more visible with light skin)  Ruddy or rosy complexion, including around the mouth 
Hair quality  Thin and wispy. May become straw-like or straighter. Dry. Falls out easily. Sparse on forearms or lower legs.  Tendency to become sparse  Tends to be coarse, sparse, may become wavy or curly (rare) or change color. If severe enough, hair loss is common. 
Nails  Thin, brittle  Break easily  May be thick 
Skin Quality  Dry, Thin, Finger-prints often "smoothed out" or flat/shiny and may have longitudinal wrinkles over finger pads (probable cause is low collagen level)  May be thin, dry, bruise easily, poor healing.  May be oily or moist. Poor healing, May bruise easily. Skin thickness is normal (not thin). Typically good quality finger prints. 
Fluids/Secretions  Dry skin, little secretions. Can't hold onto water.  Mixed, e.g. dry body and oily face  Good secretions. Skin may be oily. Tendency to fluid retention. 
Connective Tissue Quality (ligaments, tendons, skin, hair, and nails)  Lax ligaments or flexible (e.g. flat feet, double jointed). Joint strains/sprains are common.  Mixed  Poor flexibility. 
Pigment Distribution  Vitiligo (white spots or patches) in late stage. May tan too easily. In dark skin, darker on forehead, sides of face, around mouth and chin/jaw.  Milder version of vitiligo (small patches or tiny white spots on arms and/or legs) and dark patches if dark skin.  In pure hypothyroidism, vitiligo and hyperpigmentation are very rare. 
Connective Tissue Quality (ligaments, tendons, skin, hair, and nails)  Lax ligaments or flexible (e.g. flat feet, double jointed). Joint strains/sprains are common.  Mixed  Poor flexibility. 
Fluids/Secretions  Dry skin, little secretions. Can't hold on to water.  Mixed, e.g. and dry body and oily face  Good secretions. Skin may be oily. Tendency to fluid retention. 
Light Sensitivity or Night Blindness  ++ 
After Image (e.g. seeing the image of a flash bulb or bright light moving by longer than others)  ++  +/- 
Typical Pains  Headaches, migraines, muscles, carpal tunnel  Muscles, carpal tunnel  Occasionally joints, muscles, feet/lower legs 
Temperature Pattern (see Metabolic Temperature Graph)  Thermal chameleon (hot when it's warm and cold when it's cool). Poor thermoregulation. Tends to low body temperature around 97.8 or lower. Fluctuating pattern.  Fluctuating pattern, usually averaging 97.8 but can be lower  Stable, non-fluctuating pattern, average can be from low 90's to a little below 98.6 
Cold Intolerance  +++  ++  +/- 
Heat Intolerance  ++  +++ 
Cold Hands / Feet  +++  Happens often 
Warm Hands / Feet (in spite of low body temperature)  Happens occasionally  ++ 
Sweating  May be excessive in early phase. Poor sweating in late phase.  May appear normal  Normal to increased, more oily than 'wet' 
General Reactivity: Emotional, physiological, immune, etc.  Hyper-reactive (over)  Moderate  Hypo-reactive (under) 
Immune Function  Tendency to over-react results in allergies, sensitivities, autoimmune problems  Mixed  Tendency to under-respond results in infections (sinus, bladder, bowel, skin, etc.) 
History of EBV or Mononucleosis  +++  ++  +/- 
Sensitivity to medications, supplements etc. Needs small doses  ++ 
Intuitive (3). Picks up other peoples feelings (e.g. at malls, parties).  ++  +/- 
Personality Tendency: Humor  +/-  ++ 
Personality Tendency: Serious  ++/+++  ++  +/- 
Depression (10)   ++  +++ 
Anxiety(11), panic attacks, worry, fear, insecurity, feelings of impending doom (any combination). "I thought I was dying..."  +++  ++ 
Obsessive Compulsive Tendency (11) (12)  ++  +/- 
Startle Easily  ++ 
Tolerance to Change/Stress  Poor  Poor/Moderate to good  Moderate 
Sleep Patterns  Tendency to one or more: Insomnia, light sleeper, waking up at 2-4 AM, unrefreshing sleep  May or may not have sleep disturbance  Tendency to one or more: Sleepiness, narcolepsy, sleep apnea, unrefreshing sleep 
Mental Abilities  Poor focus, clarity, concentration, short-term memory. 'Brain fog'  Poor focus, clarity, concentration, short-term memory.  Poor focus, clarity, concentration, short-term memory. ‘Slow thinking’ 
Energy Pattern  Complains of fatigue or exhaustion, "wired and tired", can't persevere, low motivation  Variable energy that can be good or poor.  Complains of being tired, sluggish, low motivation 
Exercise Tolerance  Causes fatigue. Can't persevere. If severe, body temperature drops after exercise.  Mixed  Can't exercise much. Tires easily. 
Edema (swelling), non-pitting in lower legs  +/- 
Standing still is difficult or causes discomfort. Walking is easier.  +/- 
Fibromyalgia / chronic fatigue  ++  ++  ++ 
Orthostatic Hypotension (light-headed when getting up to stand from laying or sometimes, even sitting)  ++  +/- 
Blood Pressure  Tends to run low, e.g., from 80/50 at the low end to 110/70 at the high end  Can be low, normal or high  Ranges from normal to very high and poorly controlled by medications 
Heart Palpitations ("feels like my heart was about to jump out of my chest").  ++  +/- 
Mitral Valve Murmur or Prolapse (4)  ++  +/- 
Dietary Habits  Often lean toward being vegetarian or avoids certain foods  Tends to have fewer dietary restrictions than the pure adrenal type  Tends to eat everything 
Digestion  Often has difficulty digesting meat, or other proteins. Some foods troublesome (5)  May be normal or difficulty with some foods.  Poor but they often think it's good. 
Bowel Function  Tendency to be irritable, or hyperactive, transit time may be too fast (food exits stomach too fast causing poor [enzymatic] digestion)  Poor/mixed  Tendency to constipation, hypoactive, slow transit time (food leaves stomach too slowly) and poor mechanical digestion. 
Malabsorption  +++  ++ 
Cravings  Sweets, carbohydrates, salt (any combination), black licorice  Mixed  Fats 
Blood sugar. (Hypoglycemia = low blood sugar. Hyperglycemia = elevated blood sugar)  Tendency to hypoglycemia. May need many small meals or "crash"  Can range from mild hypoglycemia to hyperglycemia  Normal to hyperglycemia 
Problems with menses and /or fertility (females)  ++  +/- 
Typical Findings on Blood Tests
Blood Tests  Adrenal  Mixed (1)  Thyroid 
Chem: Total cholesterol (6)  Usually low to low normal (e.g., under 160)  Mixed: Can be low, mid-range, or high  Usually over 200. Very hard to reduce. 
Chem: HDL (6)(the good cholesterol)  Tends to be relatively high  Mixed: can be high, low, or midrange  Tends to be relatively low 
Chem: Cholesterol/HDL ratio  Usually 3.0 or less  Can be high, low or mid-range  Usually 3.5 or more 
Chem: Serum Potassium  Tends toward high normal (typically 4.0 or higher)    Tends to be under 4.0 
Chem: Serum Sodium  Tends toward low normal (typically 140 or lower)    Tends to be over 140 
Chem: DHEAS  Low to low normal     
Sugar levels  Tend to be low, e.g. 60's to 80's  Tend to be normal or elevated   
CO2  Tends to be at the low end (23 or less) (13)     
Chem: Testosterone  Tends to be low-normal to low     
CBC: WBC(7)  Tends to be low normal (e.g. 3.5 to 5)  Normal to low normal  Often in the mid-normal range or high end (e.g. above 7) 
CBC: Platelets (7)  Tend to low normal  Normal to low normal  Normal to high normal 
CBC: MCV(8)(mean corpuscular volume)  Often 93 or higher. Taking vitamin B12 regularly may normalize it.  Tends to be high or high normal. Taking B12 regularly may normalize it.  Tends to be 90 or less 
CBC: RDW (9) (reticulocyte distribution of width)  Normal to high normal  Normal to high normal  Normal to high normal 
Blood type  Most are type A    Often type O 
Platelets  Typically under 200  Typically under 300  Typically over 300