Some symptoms benefit from a more thorough investigation than a standard appointment may allow time for. When symptoms have been building for months or years, and you feel they have not been fully explored, a longer consultation with targeted pathology can sometimes uncover contributors that were not immediately apparent.
You may feel that further investigation could be helpful.
This article is about what is worth investigating when symptoms persist, and how to come into a consultation prepared.
Symptoms that may benefit from further investigation
Certain symptom clusters may warrant a closer look:
- Cognitive symptoms: brain fog, word-finding difficulty, poor focus, memory blips
- Fatigue: especially when it’s persistent and disproportionate to sleep
- Mood changes: new-onset anxiety, low mood, increased reactivity
- Cyclical symptoms: irritability, fatigue, pain or mood drops linked to your cycle
- Period changes: heavier, lighter, longer, irregular, or newly painful
- Joint and body aches: without an obvious orthopaedic cause
- Sleep disturbance: wired-but-tired waking, fragmented sleep
- Recurrent infections: UTIs, thrush, BV that keep returning
The pattern is worth noting. For some people these symptoms have a physiological contributor. For others, stress or lifestyle factors are the cause, and stress can be a valid answer. A clinician can help work out which applies to you.
What’s actually worth investigating
These are investigations a clinician may consider when symptoms persist. Which tests are appropriate depends on your individual history and assessment.
Full thyroid panel. TSH alone may not give the full picture. Free T3, free T4 and thyroid antibodies (anti-TPO, anti-thyroglobulin) can help identify subclinical and autoimmune thyroid disease that may contribute to many of the symptoms on the list above.
Iron studies including ferritin. A normal full blood count can sit alongside very low ferritin. Low ferritin levels may contribute to fatigue, brain fog and hair changes. Some clinicians consider ferritin in the lower part of the reference range as a possible contributor to fatigue in some individuals. Optimal levels are debated (Soppi, 2018).
Vitamin B12, folate and homocysteine. B12 deficiency may be common, particularly in vegetarians and women on certain long-term medications or PPIs (Langan & Goodbred, 2017). It can produce neurological and mood symptoms long before it shows on a routine CBC.
Vitamin D. May be low in a significant proportion of Australian women, despite the climate (Daly et al., 2012). Some studies have observed associations with mood, fatigue, immune function and bone health.
Reproductive markers in context. A single-point reproductive-marker reading may not be clinically useful during perimenopause because levels fluctuate significantly. Symptom patterns, cycle changes and AMH are often more diagnostically useful than a single pathology panel.
Coeliac screen. Particularly if there’s any digestive component, family history, or anaemia.
HbA1c and fasting glucose. Insulin resistance may contribute to fatigue and brain fog before glucose looks abnormal.
That’s not a maximalist workup. It’s a baseline that maps to the most common physiological causes of symptoms attributed to stress.
How to come prepared
What helps in a consultation:
Track what you’re experiencing. Two cycles of symptom diary entries (even short ones) is more useful than a paragraph of “I’ve been feeling off.” Note timing, severity (1 to 10), and what was happening that day.
Bring previous results. Pathology from the last 12 months, even if it was reported as normal. “Normal” is a band, not a point, and what’s normal for the lab’s reference range isn’t always optimal for symptoms.
Be specific about what’s different. “I used to do my full grocery shop in one trip and now I can’t” is more useful than “I’m tired.”
Ask about your investigations explicitly. “Have we checked [thyroid antibodies / ferritin / B12]?” is a fair question to raise with your clinician.
Ask for the values, not just the interpretation. “What was my actual ferritin number?” matters because flat ranges hide a lot.
What a thorough consultation looks like
It gives you the time to finish your sentences. It involves a clinician looking at the cluster of symptoms together. It usually involves pathology, often involves a return visit to interpret it, and almost always involves a written plan you can read at home.
If “just stress” has been the working diagnosis for a while and the symptoms haven’t budged, a thorough workup may be worth considering.
This article is for general information only and should not replace individual clinical advice. Individual results vary based on your individual circumstances. Assessment findings do not guarantee a particular outcome. If you are in distress or crisis, call 000 or Lifeline on 13 11 14.
Take the assessment. We’ll review it before we speak.
References
- Soppi, E.T. (2018). Iron deficiency without anemia: a clinical challenge. Advances in Therapy, 35(12), 2023-2034. doi:10.1007/s12325-018-0803-1
- Langan, R.C., & Goodbred, A.J. (2017). Vitamin B12 deficiency: recognition and management. Medical Clinics of North America, 101(2), 259-273. doi:10.1016/j.mcna.2017.06.006
- Daly, R.M., et al. (2012). Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older. Medical Journal of Australia, 196(11), 686-689. doi:10.5694/mja11.10301
