From the Practice · Dr. Romanos
Investigating fatigue medically — systematic, not guesswork
Fatigue is one of the most common symptoms in GP practice — and one of the hardest to pin down. Most patients come after weeks of accepting "it's just stress." But chronic fatigue often has treatable causes.
When fatigue should be investigated
If fatigue persists beyond 4 weeks, can't be explained by lack of sleep, limits your performance, or comes with other symptoms (hair loss, weight gain, concentration problems), medical investigation is warranted.
What I investigate as standard
In my practice, I start with structured lab work: blood count, ferritin, vitamin B12, vitamin D, thyroid (TSH, fT3, fT4), liver and kidney values, HbA1c, CRP. Where hormonal issues are suspected, I add cortisol and sex hormones. This covers the most common organic causes.
The most common causes in my practice
Iron deficiency, vitamin D deficiency, hypothyroidism, B12 deficiency, and insulin resistance are my "top 5" findings for fatigue. All treatable, all frequently missed. Details in our article Fatigue: 7 medical causes.
What if everything comes back normal?
If lab work is unremarkable, we look further: sleep quality, mental health, diet, exercise. Sometimes a sleep apnoea investigation is warranted. The point is: we don't stop after the first normal blood count. Fatigue deserves thorough investigation.
Next step: Book a consultation to discuss your health in detail.
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