CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Tiredness/fatigue in adults - Management
What second-line investigations should I offer, and when?
- If tiredness has persisted for 3 months or longer:
- Ensure that all of the following investigations have been done to rule out other diseases and conditions besides chronic fatigue syndrome (CFS)/myalgic encephalitis or encephalopathy (ME):
- Urinalysis for protein, blood, and glucose.
- Full blood count.
- Urea and electrolytes.
- Liver function tests.
- Thyroid stimulating hormone.
- Erythrocyte sedimentation rate or plasma viscosity.
- C-reactive protein.
- Random blood glucose.
- Serum creatinine.
- Serum calcium.
- Creatine kinase.
- IgA tissue transglutaminase for coeliac disease (provided the person consumes gluten-containing foods).
- Offer tests for the following infections only if the history is indicative:
- Chronic bacterial infections, such as borreliosis (Lyme disease).
- Chronic viral infections, such as HIV or hepatitis B or C.
- Latent infections, such as toxoplasmosis, Epstein–Barr virus, or cytomegalovirus.
© NHS Institute for Innovation and Improvement