10/20/2022
“Fatigue-ologists”
Endocrinologists are being asked to evaluate patients with fatigue despite normal initial Endocrine workup by their primary care doctors. Patients come to us with the notion that we will be able to figure out their fatigue. There’s a misconception we will run more thyroid tests, run extensive hormone testing and find the root cause of the fatigue.
Despite our best efforts of checking pertinent Endocrine work up, we often come back empty handed from the Endo standpoint. . We often have to tell a disappointed patient that “all your Endocrine work up is normal. I do not see an Endo explanation for your fatigue.”
Here is a plea to our referring doctors and to our patients. Please understand that Endocrinologists are not your Fatigue doctors. Please don’t set up unrealistic expectations that we will figure out the cause of the fatigue. We are more than happy to help navigate a possible Endocrine disorder if initial workup suggests a possible issue; however, if there is no clear endocrine indication, it’s best to avoid an Endo referral just to “figure out” the fatigue. Unfortunately, we don’t have the answers either beyond sleep/diet/stress/sleep apnea/vitamin deficiencies/ etc. These aren’t Endo issues. If thyroid levels are normal, it’s generally not the thyroid. We don’t have much more extensive testing than what’s done with the primary care doctor. For patients with hypothyroidism, we may consider T3 treatment but beyond that, we often don’t have that much more to add.
Endocrinologists generally tend to be an empathetic group of doctors so we want to help you feel better and feel bad for the fatigue many of our patients experience. However, given the shortage of Endos and long wait times, we want to be sure the patients who are referred to us (or self referred) are appropriate for an Endo clinic.
On one hand, we don’t want to see patients go to quack clinics for their fatigue. (There are so many). On the other hand, there’s a shortage of Endos so we need to be sure we are seeing appropriate referrals. A great primary care physician is the first step in evaluating these patients appropriately.
