Authors: Evans, Kate M.; Flanagan, Daniel E.; Wilkin, Terence J.

Source: Clinical Medicine, Journal of the Royal College of Physicians, Volume 9, Number 1, February 2009 , pp. 34-38(5)

Publisher: Royal College of Physicians

Abstract:

Fatigue and stress-related illnesses often become diagnoses of exclusion after extensive investigation. 'Tired all the time' is a frequent reason for referral to the endocrine clinic, the implicit question being - is there a subtle endocrine pathology contributing to the patient's symptoms? Often initial assessment suggests not but there are no clear data to address the question of whether overt pathology will develop in the future. This study observed outcomes after five years in 101 consecutive and unselected referrals to secondary care for 'fatigue?cause', where initial assessment did not suggest treatable endocrine pathology. The findings suggest that the clinical diagnosis of fatigue, based on history and tests to exclude anaemia, hypothyroidism and diabetes, is secure: these patients do not subsequently demonstrate excess morbidity and mortality, and their presenting symptoms are not early features of significant endocrine pathology.

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Keywords: CHRONIC FATIGUE; CLINICAL REASONING; SUBCLINICAL THYROID DISEASE

Document Type: Research article

Publication date: 2009-02-01

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• Clinical Medicine is published six times a year and circulated to 20,000 Fellows and Members of the Royal College of Physicians. The journal is read by physicians both established and in training in hospitals across the world. It features a wide range of articles including original papers, professional issues, clinical guidance, medical humanities, ethics and clinical governance. The journal publishes the key features from the College lectures and conferences. Each issue has a CME section which reviews the latest advances in a chosen specialty.
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