Tiredness is a common symptom in primary care, with causes ranging from psychological to social and physical (25%). It is a symptom common to many diseases where the overall pattern of symptoms makes the diagnosis relatively straightforward. Nevertheless patients may not realise the link between their illness and their tiredness and will be helped by a careful explanation.

History

The history is crucial: see Figure 63.

Examination

Look for pallor (an unreliable indicator of anaemia), obesity, hypothyroidism and thyrotoxicosis (and don’t forget rare endocrine conditions like Cushing’s and Addison’s). Weight loss may be indicative of malignancy or thyrotoxicosis (although is most commonly psychosocial). Measure the patient’s weight and calculate the BMI. Examination should be directed by the findings in the history.

Investigations to be considered in primary care: FBC (and vitamin B12, folate, serum iron and ferritin if warranted); U&E and LFT for renal and liver disease; TFT for thyroid problems; fasting glucose for diabetes; Monospot or Paul–Bunnell tests for infectious mononucleosis; vitamin D levels commonly reveal deficiency and may present with non-specific aches and pains or weakness. ESR/CRP are non-specific tests of inflammation and may be helpful in differentiating physical from psychological disease.

Chronic Fatigue Syndrome (CFS)

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