I don’t know what’s causing my fatigue. What should I look into?
April 18, 2021 4:54 AM   Subscribe

I’ve developed severe chronic fatigue within the last year and I don’t know why.

Here are some of the things I’ve been tested and/or treated for:

-Sleep apnea
-Depression and anxiety
-COVID-19 (tested negative, never had more than a cough)
-Anemia (iron deficiency)

What else should I have my doctor look into?

My symptoms vary a lot in severity from day to say. On the best days, I can go for a very slow hour-long walk and struggle and take lots of tests but be okay. On the worst days, I can’t even stay standing long enough to take a shower.
posted by fruitdroid to Health & Fitness (30 answers total) 20 users marked this as a favorite
Response by poster: P.S. I use they/them pronouns.
posted by fruitdroid at 4:55 AM on April 18, 2021

Thyroid again, especially if you appear to be female. Thyroid issues can be underdiagnosed/misdiagnosed (different docs use different scales) or simply discounted as "female issues/weight gain problems" by less-than-careful medical professionals. Endocrinologist preferred over GP, generally.

I have encountered this precise issue, and thus feel it wise to mention again. Best of luck to you.
posted by WaywardPlane at 5:07 AM on April 18, 2021 [1 favorite]

Do you know what your vitamin d levels are?
posted by Zumbador at 5:43 AM on April 18, 2021 [1 favorite]

Vitamin D, you want to be near the upper bound of normal. Insulin resistance, not just diabetes (insulin AND glucose testing at fasting plus an hour and two hours after a portion of glucose). Blood pressure, through continuous at-home testing.

And seconding WaywardPlane. The TSH norm is up to 4, but that's the healthy young male one - my endocrinologist wants me at 2 and I feel strong fatigue if I let it go higher.
posted by I claim sanctuary at 5:43 AM on April 18, 2021 [2 favorites]

I am someone with an underactive thyroid whose labs were considered normal by many doctors. A small dose of thyroid medication solved so many tired/exhaustion/lack of motivation issues (which got called all kinds of things, including major depression and fibromyalgia). The medication decreased my sleep from 12 to 14 hours a day to 8 to 9 and I stopped taking naps at every available second. It was a lifechanger.
posted by AlexiaSky at 5:50 AM on April 18, 2021 [6 favorites]

Big Five: B12, Vit D, Folate/Ferratin, Thyroid, Mono/Epstein Barr.
posted by DarlingBri at 6:28 AM on April 18, 2021 [13 favorites]

Don't rule out Long COVID.
posted by kathrynm at 7:50 AM on April 18, 2021 [4 favorites]

Seconding Vitamin D. When getting a test for Vit D, ask for the numbers and get tests as you go along, so you know what your 'normal' is.

This may also be true for thyroid and anemia, especially ferritin.
posted by Ms. Moonlight at 8:30 AM on April 18, 2021 [2 favorites]

My fatigue got a lot better when we treated my anemia, low Vitamin D, & low Vitamin B-12.
posted by belladonna at 8:32 AM on April 18, 2021

Lyme's disease?
posted by AugustWest at 8:37 AM on April 18, 2021 [1 favorite]

Chili worked for me.
posted by flabdablet at 9:17 AM on April 18, 2021 [1 favorite]

You could consider keeping a journal of your symptoms as well as what food you eat and anything else that seems relevant. Sometimes food sensitivities cause fatigue. An elimination diet is an option, too. Maybe ask about Celiac disease.
posted by Comet Bug at 10:54 AM on April 18, 2021

I hate to suggest this, but have you had blood work done looking for malignancies?
posted by porpoise at 10:59 AM on April 18, 2021 [1 favorite]

As for the possibility of long COVID, it should be possible to get tested for COVID antibodies, which could indicate if you have had COVID in the past without knowing it or showing any symptoms at the time of the infection. (Ask your doctor, don't, like, buy something online claiming to test for this.)

I don't think this will work if you have been vaccinated, though. You'll test positive for antibodies in any case then (which is a good thing, but unrelated to what you're wanting to find out here).
posted by Juffo-Wup at 11:04 AM on April 18, 2021

Autoimmune diseases such as arthritis and lupus will do this to you.
posted by The Underpants Monster at 11:39 AM on April 18, 2021 [2 favorites]

Testing Recommendations for Suspected ME/CFS - US ME/CFS Clinician Coalition
Chronic Fatigue Syndrome: A Roadmap for Testing and Treatment - this is by a layperson with ME/CFS in the UK
posted by jocelmeow at 11:41 AM on April 18, 2021 [1 favorite]

More than "what" I'll suggest "who": an endocrinologist, and a rheumatologist, if you can and haven't yet. No shade on whoever you've been seeing, but you still have the problem, so time to escalate.
posted by away for regrooving at 11:50 AM on April 18, 2021 [4 favorites]

Everyone has great suggestions above but I just wanted to add in that the stress of living through this insane time might also be a culprit. Neither my partner nor I have been sleeping well, and my partner, who is normally a pretty energetic guy, has been finding that he is absolutely exhausted by 4pm everyday regardless of whether he's been doing active activity or just working on job applications and other more "sitting a lot" activities. I suspect he may also be dealing with some mild situational depression at the moment. Don't rule out the idea that you might be experiencing COVID burnout from isolation, depressing news, job stress, etc. I myself feel like I have hit a wall in the past few months, even after getting vaccinated. I just feel drained. Definitely look into Vitamin D and anemia as they are common culprits, but also remember that we have just gone through the most stressful year most of us have experienced, and even with no more Trump and people getting vaccines, it's still hard to predict when the world will go back to normal, or if that normal will even look like the normal we remember. This is taxing on the psyche even if you don't have a formal diagnosis of depression or anxiety and can lead to fatigue.

I hope you feel better soon. This is still just a hard time right now.
posted by nayantara at 1:32 PM on April 18, 2021 [4 favorites]

B12 B12 B12 B12. I have pernicious anemia and when my B12 is low, I'm just....wrecked. (Also agreeing with the Vitamin D and ferritin suggestion. I have normal iron, but my ferritin is really low so I need supplements. Docs don't always test your ferritin automatically.)
posted by Countess Sandwich at 1:36 PM on April 18, 2021 [2 favorites]

Hello - this is exactly my scenario.

I got sick in March, 2020 with a COVID-like illness, and got tested for COVID - negative. I also got tested for COVID antibodies in December, 2020 - also negative. I only had cough, fever, chills, and shortness of breath, but not enough to be hospitalized. I did have to have 2 months of Prednisone afterwards, though, to straighten out my lungs, as it made my asthma markedly worse. Current theory is that I had the Influenza instead of COVID, as I had gotten my flu vaccine really early the year previous, and it wore off already.

Ever since then? Chronic Fatigue. I do exertion, and the next day? Fever, chills, malaise, brain fog. It's horrible.

One thing that did help, though? Getting my COVID vaccinations. It's been two weeks since I've gotten my second dose of Pfizer, and I feel markedly better. For instance - I walked over 15,000 steps on Friday, and was able to work all day yesterday. And I'm at work today as well. I don't feel 100% yet, but I do feel that I am getting there. I may not have had actual COVID-19, but it is jumpstarting my immune system back up.

So, assuming you're in a place where COVID vaccinations are being given out, and you qualify for the vaccine, I'd try to get your set of vaccines ASAP. Even if it doesn't help, you'll at least be protected from this horrible disease.
posted by spinifex23 at 1:41 PM on April 18, 2021 [2 favorites]

Here is an article explaining more about Long Covid, and how the vaccine helps: Mysterious Ailment, Mysterious Relief: Vaccines Help Some COVID Long-Haulers.
posted by spinifex23 at 1:44 PM on April 18, 2021 [1 favorite]

I mean, I have been intending to shower for the past four hours and the thought of getting off the couch and up the stairs is too much for me to fathom because I'm so wiped. I did nothing today but work on my laptop. Just to give you an example. The stairs in particular are daunting. I feel out of breath walking up, and I'm not even in that bad shape.
posted by nayantara at 1:50 PM on April 18, 2021

I've heard of adrenal gland inefficiencies causing fatigue.
posted by DixieBaby at 1:50 PM on April 18, 2021

Vitamin D and B12 have been deficient for me at various points and supplementation seems to have helped my energy levels. I take one Nature Made 5,000 IU D3 gelcap and two Nature Made Energy B12 1000 mcg gummies daily to avoid those deficiencies.

Also, drinking green tea seems to help give me a long-term boost of energy over the course of the day on the days I have it; it contains a substance that is thermogenic, thus it helps boost your metabolism, and also is anti-inflammatory. (I think it's helping me get more active while reducing pain, along with CBD gelcaps and Aleve as needed.)

I also have Hashimoto's thyroiditis; technically, it's not causing hypothyroidism for me yet, but we'll have to continue keeping an eye on it. I also have polycystic ovarian syndrome. So to help thyroid function, which could be impacted by those, per my endocrinologist's suggestion to supplement with selenium, I'm also eating two Brazil nuts daily. (Selenium supplements taste like garbage garlic.) Per restless_nomad's great suggestion to my most recent question, I get chocolate-covered Brazil nuts autodelivered by Nuts.com now. So it's also possible that's improving my energy levels.

So those things have helped for me. But the way I found out about the thyroid-related stuff was going to an endocrinologist. So that would be my suggestion for you. Go to a dedicated endocrinologist and get blood work done to see what might be going on.
posted by limeonaire at 5:01 PM on April 18, 2021 [2 favorites]

Oh right, the other thing I've been trying for a few months: going gluten-free. I had some gluten-containing food again recently and it definitely knocked me out. I have to eat more this week so I can get a blood test next week, so we'll see what it actually shows, but yeah, gluten definitely was seeming to reduce my energy levels when I was eating it before. So that's something else you could get tested for, a gluten intolerance or sensitivity.
posted by limeonaire at 5:34 PM on April 18, 2021

I ended up being diagnosed with fibromyalgia for these symptoms - it took doctors around 2 years to reach that point though, after going through all of that same stuff.

For other people I've known who've had the same diagnosis as me, lyrica worked really well to lift the fog. Sadly, I'm allergic to both it and the other mainline treatment for this, gabapentin. But you may not be - my mother had the same issues (interestingly, at around the same age it ramped up for me), and lyrica completely changed her life. Your mileage will, of course, vary - but this might be something you could go to your doctor with...

In particular - if the fatigue is also combined with muscle aches, don't discount the aches - one of my early missteps was to do that, and it turns out that if I had not, then they say they would have diagnosed me sooner. again, your health and mileage will vary
posted by jaymzjulian at 8:04 PM on April 18, 2021 [3 favorites]

Rheumatologists solve mysteries like this. Even if it turns out you don't have something that causes this kind of fatigue they usually treat--auto-immune/inflammatory arthritis, lupus, fibromyalgia--they are the people who think through these problems and come to diagnoses by eliminating all the other possibilities.
posted by hydropsyche at 4:44 AM on April 19, 2021 [3 favorites]

I am in a similar boat and my doctor thinks it is a post viral syndrome similar to long hauler COVID but, in my case, caused by the Mono virus. It doesn't seem like there is a ton to be done about it. After 18 months of trying to 'cure' it I am now trying to manage my symptoms instead. One thing that has been SUPER helpful is a low dose of Modafinil in the mornings- a mild stimulant. It has really been a game changer for me. My doctors arrived at this diagnosis basically by eliminating other possibilities. What's hard is that post viral syndrom/chronic fatigue really doesn't live with any one specialist. I spent a lot of time getting booted from infectious disease, to rheumatology, to immunology with everyone kind of shrugging and saying it wasn't in their wheelhouse. In the end, finding a really good primary care doctor was the most helpful piece because she has really quarterbacked the whole thing. I wish you the best of luck. This is a hard thing to deal with.
posted by jeszac at 7:29 AM on April 19, 2021 [2 favorites]

Nthing the advice to see a rheumatologist. I started experiencing something similar right before COVID started, so I knew it wasn't Long COVID and suspected it wasn't JUST the effects of social isolation (though I can't imagine that helps). I also had some serious muscle and joint pain, so I went to a rheumatologist who diagnosed me with fibromyalgia, which is related to CFS/ME. (Fibro is also a potential diagnosis for you)

Also Nthing the Vitamin D test rec. I was severely Vitamin D deficient once and it was shockingly debilitating, but very easy to treat.
posted by lunasol at 11:09 AM on April 19, 2021

Reasons I have felt fatigued (ranging from tired to barely functional):
1. Severe Vitamin Deficiencies - B12, D, Iron (diagnosed via blood work, treating with vitamins or injections)

2. Thyroid Issue - I was very recently diagnosed with Graves disease and it knocked me on my butt (treating with medication) ... so you were checked for hypothyroidism, but was that recent? what about hyperthyroidism? I have no clue if that would be a different test or not. Also don't rule something out because you don't have all of the most common symptoms - TEST! TEST! TEST!

All my issues relate back to an overactive immune system (which I have always described as my immune system hates me), but vitamin deficiencies are super common and can wreck havoc on the body.

All of these issues have been diagnosed and addressed via my primary care doctor, hematologists and endocronolgists.

Hope you can get a clear diagnosis and get it under control!
posted by Julnyes at 8:34 AM on April 20, 2021 [1 favorite]

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