TürkçeFatigue is a general state of weakness that occurs as a result of disruptions in the body’s energy production and utilization processes. The most common causes include iron deficiency anemia, thyroid dysfunctions, infections, chronic diseases, and psychological stress. Metabolic imbalances reduce cellular energy production and lead to loss of performance.
Persistent weakness and fatigue are generally associated with vitamin and mineral deficiencies, sleep disorders, and hormonal changes. In particular, deficiencies of vitamin B12, vitamin D, and iron prevent sufficient oxygen from being transported to the tissues. This condition is accompanied by decreased muscle strength, lack of concentration, and significant difficulty in daily activities.
Daytime sleepiness and exhaustion may result from physiological or psychiatric factors affecting the central nervous system. Conditions such as sleep apnea, depression, and insulin resistance impair the quality of restorative sleep. An inadequate cellular renewal process causes the feeling of fatigue to continue even in the morning hours.
The symptoms and treatment of chronic fatigue are planned by accurately identifying the underlying cause. Detailed blood tests, hormonal evaluations, and imaging methods considered necessary are important in the diagnostic process. Treatment is carried out holistically through nutritional regulation, correction of deficiencies, and lifestyle changes.
Are Fatigue and Tiredness Psychological?
When our patients present with complaints of fatigue, they often state that they frequently hear comments from people around them such as “yours is completely due to stress.” Yes, statistics show that approximately 80% of fatigue complaints are related to lifestyle and psychological state. However, the remaining 20% is of vital importance to us. If fatigue does not improve with rest, if a person wakes up in the morning feeling as though they have not slept at all and as if they have been beaten, and if this condition is accompanied by a decrease in physical capacity, then we need to move away from psychological causes and focus on organic causes.
From the perspective of thoracic surgery, fatigue caused by a problem within the chest results from the inability of the lungs and heart, the body’s energy centers, to maintain their normal functioning. The body expends an enormous amount of energy to fight an internal disease, which may be a tumor, an infection, or a mechanical disorder. This battle continues in the background even if you are unaware of it, leaving no energy for your daily activities. Therefore, in the presence of the conditions listed below, it would be most appropriate not to attribute the issue solely to stress and to consult a specialist.
Some signs suggesting fatigue of organic origin are as follows:
- Unintentional weight loss
- Night sweats
- Persistent cough
- Shortness of breath
- Chest pain
- Difficulty swallowing
- Hoarseness
- Drooping eyelid
Does Lung Cancer Cause Fatigue?
Lung cancer is unfortunately one of the most serious health problems of our time and is the field to which thoracic surgery clinics devote the most intensive effort. The most insidious and widespread symptom of this disease is unquestionably fatigue. Clinical studies show that more than half of patients with lung cancer have difficulty even performing the simplest daily tasks, such as carrying grocery bags or climbing stairs. So how can a mass in the lung drain the strength from your legs?
To understand this, it is necessary to know the nature of cancer cells. Cancer cells are much more voracious than the body’s normal cells. Because they want to multiply uncontrollably, they attack all of the body’s energy reserves. Glucose, protein, and other building blocks obtained from the foods you eat are used by these tumor cells before your healthy muscles can use them. We call this a “hypercatabolic state.” In other words, even while you are sitting still, your body burns calories and exhausts itself as though you were performing heavy labor. This “energy theft” leads to unexplained weight loss and muscle wasting in the patient.
In addition, as tumor tissue grows, it releases certain chemicals and waste products into the bloodstream. These substances create a constant state of inflammation in the body. The immune system remains continuously on alert in order to cope with this situation. This chronic state of battle creates a feeling of malaise, exhaustion, and depletion in the patient, similar to having the flu. This condition may even affect the chemical balance in the brain and eliminate the person’s desire to move, or motivation. Therefore, fatigue in lung cancer is not merely physical weakness but a systemic deterioration affecting the entire body.
What Is the Relationship Between Anemia and Fatigue?
One of the most concrete and measurable causes of fatigue is anemia. Anemia is very common in chronic diseases such as lung cancer or during chemotherapy. The red blood cells in our blood are like transport trucks that carry oxygen to every part of the body. If the number of these trucks decreases, sufficient oxygen cannot reach the tissues and muscles.
Oxygen is the fuel required for the muscles to work. Just as an engine without fuel sputters, muscles deprived of oxygen become tired with the slightest movement. The patient may become short of breath and experience severe palpitations even when simply getting up from a chair and walking to the kitchen. This affects not only the muscles but also the brain; concentration problems, dizziness, and constant sleepiness develop. Especially in patients receiving chemotherapy, this condition may occur at rates of 75-100%.
At this point, not only blood cells but also the body’s electrolyte balance is very important. Minerals such as sodium, potassium, calcium, and magnesium are like “battery fluid” that enables the nerves to transmit commands to the muscles. When certain hormones secreted by tumors or nutritional disorders disrupt the balance of these minerals, the muscles cannot carry out the brain’s command to “move.” Correcting these imbalances before surgery is vital for the patient to tolerate the operation and recover rapidly afterward.
Symptoms caused by anemia and electrolyte disorders are as follows:
- Palpitations
- Dizziness
- Pale skin color
- Shortness of breath
- Forgetfulness
- Muscle cramps
- Numbness in the hands
Which Disease Do Drooping Eyelids and Fatigue Indicate?
One of the most interesting and specific types of fatigue we encounter in thoracic surgery practice is the disease called “Myasthenia Gravis.” The fatigue experienced in this disease has a very different character from other types. The patient generally wakes up in the morning feeling quite refreshed and energetic. However, as the day progresses and the muscles are used, the patient slows down and loses strength like a toy whose battery is running out. Toward the evening, the patient has difficulty keeping the eyelids open, begins to experience double vision, develops a strained voice while speaking, and has difficulty swallowing. After resting for a while, these symptoms partially improve and strength returns.
The cause of this fluctuating fatigue is a breakdown in communication between the nerve endings and the muscles. Normally, commands from the brain reach the muscles through the nerves, but in this disease the body’s own immune system attacks this communication point and prevents the command from reaching the muscle. This is where thoracic surgery becomes involved. This is because the origin of the disease lies in the “Thymus” gland, located in the front part of the chest, immediately behind the breastbone.
In the majority of patients with Myasthenia Gravis, enlargement of the thymus gland or a tumor, called a thymoma, is detected. Surgical removal of this gland, known as a thymectomy operation, can completely change the course of the disease. Today, it is no longer necessary to open the chest from top to bottom for these operations. The thymus gland can be removed through three small incisions made from the side using closed techniques known as robotic surgery or VATS. After this procedure, the need for medication decreases in a large proportion of patients, and in some patients the disease disappears completely, which is called remission.
Typical symptoms seen in Myasthenia Gravis are as follows:
- Drooping eyelid
- Double vision
- Speech disorder
- Difficulty swallowing
- Fatigue while chewing
- Weakness in the arms and legs
- Difficulty breathing
Does Funnel Chest Cause Fatigue?
Pectus Excavatum, commonly known as “Funnel Chest,” is a condition in which the breastbone, or sternum, is sunken inward. Young people in adolescence or their families generally view this condition only as an aesthetic concern or an appearance problem. However, when these young patients who present to the outpatient clinic are questioned in detail, it becomes apparent that they actually become tired much more quickly than their peers. Complaints such as “I cannot run as much as my friends while playing football, I get out of breath immediately” or “My heart feels like it is pounding out of my chest when I climb stairs” are evidence that this deformity is not merely cosmetic.
The reason for this early fatigue is entirely mechanical. The inwardly sunken breastbone applies physical pressure to the heart and lungs located directly behind it. In particular, when the right ventricle of the heart is under this pressure, it cannot expand fully and fill with blood. Therefore, the amount of blood pumped to the body with each heartbeat is lower than it should be. This condition may not cause a problem while the person is at rest; however, when the body needs more oxygen during exercise or running, the compressed heart cannot meet this demand. As a result, the young patient becomes exhausted early, becomes short of breath, and feels weak.
The Nuss procedure or open surgical methods used in the treatment of this condition do not merely correct the shape of the chest; they also free the heart. When the depression is corrected with the help of a bar placed beneath the breastbone, the pressure on the heart is relieved. Scientific tests have shown that after surgery, these patients’ exercise capacity and oxygen consumption levels increase significantly. In other words, the treatment restores the energy the patient has lost.
Complaints that may accompany funnel chest are as follows:
- Exercise intolerance
- Palpitations
- Chest pain
- Shortness of breath
- Easy fatigability
- Feeling faint
Do Diaphragm Problems Cause Sleepiness?
When we think of respiration, the lungs always come to mind, but the main driving force that enables us to breathe is the “diaphragm” muscle. This thin layer of muscle that separates the chest cavity from the abdominal cavity contracts and moves downward with every breath we take, creating space for the lungs to fill with air. However, in some cases, paralysis of the diaphragm may develop due to nerve damage, or the diaphragm muscle may become relaxed and rise upward toward the lung, which is called eventration.
For a patient whose diaphragm does not work or has risen upward, lying down in particular may become torture. When the patient lies on the back, the organs in the abdomen, including the stomach, liver, and intestines, push the relaxed diaphragm upward under the effect of gravity and compress the lungs. This causes lung capacity to decrease significantly during sleep. As a result, the patient cannot breathe comfortably throughout the night, the oxygen level in the blood decreases, and sleep is frequently interrupted, resulting in sleep apnea.
A patient who cannot obtain quality sleep throughout the night, cannot enter the deep sleep phase, and remains deprived of oxygen wakes up in the morning extremely tired, with a headache, and feeling completely unrested. The patient experiences constant daytime drowsiness, or somnolence, concentration problems, and persistent fatigue. These patients are often mistakenly diagnosed with depression or only sleep apnea. However, the problem is mechanical and the solution is surgical. With the procedure called “Diaphragm Plication,” the relaxed diaphragm muscle is tightened, lowered to a lower level, and sutured. This creates space for the lungs and prevents pressure from the abdominal organs. After surgery, both the sleep quality and daily energy levels of patients improve dramatically.
The main problems seen in diaphragm disorders are as follows:
- Inability to lie on the back
- Shortness of breath with exertion
- Excessive daytime sleepiness
- Morning headaches
- Frequent awakenings
- Snoring
Is Fluid Accumulation in the Lung a Cause of Fatigue?
Fluid accumulation between the lung membranes, which we call “pleural effusion” in medical terminology, is another condition that causes severe fatigue in patients. The fluid accumulating around the lung compresses the lung tissue from the outside like a corset and prevents it from expanding. With every breath, the patient has to make an extra effort to overcome the resistance of this fluid and inflate the lung. The patient expends much more energy than a healthy person does simply to breathe.
In addition, the feeling of heaviness caused by the fluid, constant side pain, and cough reflex exhaust the patient both physically and mentally. This creates a vicious cycle: The patient becomes afraid to move because of shortness of breath, physical condition deteriorates due to inactivity, and the muscles weaken; as the muscles weaken, fatigue increases further.
As thoracic surgeons, in this situation we first try to understand the cause of the fluid. Is it heart failure, pneumonia, or a tumor-related condition? For diagnostic and relief purposes, we drain the fluid through a procedure called “Thoracentesis.” Draining the fluid provides immediate relief to the patient. If the fluid repeatedly accumulates due to cancer, we eliminate the space where the fluid can collect by performing a procedure that adheres the lung membranes to each other, called pleurodesis. Sometimes the fluid remains there for a long time, becomes inflamed, and forms a thick rind around the lung. In this case, the lung becomes trapped. With a “Decortication” operation, we peel away this rind and free the lung again. When the lung begins to function at full capacity again, the patient’s oxygenation improves and fatigue disappears.
The most common causes of pleural effusion are as follows:
- Lung infections
- Heart failure
- Lung cancer
- Breast cancer metastasis
- Tuberculosis
- Kidney failure
Which Methods Are Used to Diagnose Fatigue?
In a patient presenting with fatigue, if imaging examinations such as computed tomography or X-ray reveal a suspicious condition within the chest, it is necessary to “name the enemy” before planning treatment. At this stage, the patient and relatives generally become concerned, but with today’s technology, making a diagnosis is now much easier and more comfortable. In thoracic surgery, we prefer minimally invasive methods that cause the least possible damage to the body.
If suspicious lymph nodes or masses are present, we can sometimes obtain a biopsy through a very small incision made in the neck, called Mediastinoscopy, or without any incision by examining the inside of the trachea with ultrasound, called EBUS. These procedures generally allow the patient to return home on the same day. If the problem is located in the more peripheral parts of the lung or if there is fluid in the pleura, we can enter between the ribs using the closed camera method called VATS and both establish the diagnosis and provide treatment in the same session. The purpose of these methods is to establish the most accurate diagnosis without exposing the patient to the stress of a major operation and to determine the most appropriate treatment approach, whether surgery, chemotherapy, or other treatments.
The main methods used during the diagnostic stage are as follows:
- Lung computed tomography
- PET-CT scan
- Bronchoscopy
- Mediastinoscopy
- EBUS
- VATS
- Thoracentesis
How Long Does Fatigue Last After Surgery?
Thoracic surgery operations are major events for the body. Although they are therapeutic procedures, surgical intervention is a source of trauma and stress for the body. Therefore, it is completely normal and expected for weakness and easy fatigability to continue for some time during the postoperative period. The body uses a large portion of its energy to repair the tissues that have been cut, regulate the immune system, and adapt to the new condition.
In general, we explain to our patients that postoperative tiredness and fatigue may continue for up to three months, although they gradually decrease. However, this period may vary depending on the extent of the operation, the patient’s age, and accompanying diseases. The most important point here is the concept of “active rest.” In the past, patients were advised to remain in bed continuously, but today we know that this delays recovery. Staying in bed for a long time leads to muscle loss, decreased lung capacity, and an increased risk of blood clots.
For this reason, we begin walking our patients on the day immediately after surgery. After discharge, it is also very important to take frequent walks inside the home and use breathing exercise devices with balls called “Triflow.” Good pain control increases the patient’s desire to move. In addition, consuming a diet rich in protein and calories during the recovery period replaces the building blocks needed by the body. Remember, movement after surgery is the medicine for fatigue. The earlier you begin moving, the sooner your energy level returns to normal.
Recommendations that accelerate postoperative recovery are as follows:
- Regular walking
- Breathing exercises
- High-protein nutrition
- Drinking plenty of water
- Regular sleep
- Avoiding smoking
- Psychological support
Frequently Asked Questions
Fatigue may develop due to many causes, including anemia, thyroid diseases, vitamin deficiencies, infections, chronic diseases, insufficient sleep, and intense stress. If the complaints persist, the underlying cause must be investigated.
Persistent fatigue and sleepiness may be early signs of diabetes, thyroid disorders, heart diseases, depression, sleep apnea, and certain infections. If the complaints persist for a long time, comprehensive medical evaluation is important.
During the diagnostic process, the patient’s medical history, physical examination, and blood tests are prioritized. When necessary, thyroid functions, vitamin levels, blood glucose, infection markers, and other advanced tests are evaluated to determine the cause.
Deficiencies of iron, vitamin B12, and vitamin D may negatively affect energy production and bodily functions. Because these deficiencies may cause fatigue, reduced concentration, muscle weakness, and tiredness, appropriate treatment should be planned.
Intense stress, anxiety disorders, and depression may cause persistent fatigue even in the absence of physical illness. Evaluating psychological and physical causes together is important for accurate diagnosis and effective treatment.
If fatigue is accompanied by weight loss, high fever, shortness of breath, chest pain, fainting, or prolonged complaints, a doctor should be consulted without delay. These symptoms may be signs of important diseases.
Eating a balanced diet, drinking enough water, sleeping regularly, remaining physically active, and controlling stress may increase energy levels. If the complaints continue, lifestyle changes alone should not be considered sufficient.
Sleep apnea impairs sleep quality by causing repeated interruptions in breathing throughout the night. This condition may manifest as excessive daytime sleepiness, reduced concentration, and persistent fatigue.
Although fatigue may occur at any age, it may be more common in some people because of advanced age, chronic diseases, hormonal changes, and an intense pace of life. Prolonged complaints in children and young people should also be evaluated.
Fatigue treatment is planned according to the underlying cause. In many patients, complaints may decrease significantly by correcting vitamin deficiencies, controlling chronic diseases, and making lifestyle adjustments.
Prof. Dr. Alper Fındıkcıoğlu graduated from Istanbul University Faculty of Medicine and completed his thoracic surgery residency at Dr. Siyami Ersek Hospital. He began his academic career at Başkent University in 2005; he received the title of associate professor in 2014 and professor in 2022. He has extensive experience in lung cancer, chest wall diseases, and minimally invasive surgery. Since 2024, he has been continuing his professional work at Acıbadem Hospital.
