Why Am I Always Tired? A Real Answer, From a Utah Physician.

The 7 most common real causes of persistent fatigue

In our Salt Lake City clinic, these are the patterns we find most often in patients who come in "too tired to live their life."

• Subclinical thyroid dysfunction (high-normal TSH, low-normal Free T3)
• Dysregulated cortisol rhythm (wired at night, flat in the morning)
• Iron deficiency without anemia (ferritin < 50 despite "normal" CBC)
• Chronic low-grade inflammation (hs-CRP, homocysteine)
• Insulin resistance well before diabetes criteria
• Mold or mycotoxin exposure from Utah basements + HVAC
• Sleep architecture issues — fragmentation, low deep sleep, poor HRV

Why standard labs miss this

Standard panels use population-wide ranges that include people who quietly are not well. Functional ranges are narrower and validated against how healthy people actually perform. A TSH of 3.9 is "normal" — and absolutely correlates with the fatigue you feel.

What to do about it

Most patients start with the Essential Wellness Lab Panel to establish a functional baseline across thyroid, metabolism, inflammation, and nutrients. Patients with multiple overlapping symptoms move straight to Root Cause Advanced so Dr. Thomas can evaluate hormones, toxins, and gut together.