Why are my hands and feet always cold?

Photo: Alex Wong/Unsplash. Design: BOOST Thyroid.

Photo: Alex Wong/Unsplash. Design: BOOST Thyroid.

Cold hands and feet are common symptoms of an underactive thyroid. They can also be symptomatic of Raynaud’s syndrome—a non-serious phenomenon where blood vessels in the hands and toes are constricted during cold temperatures or stressful situations (1).

In the case of Hashimoto’s and hypothyroidism, sensitivity to cold temperatures is typical (2). So if you’re in a room that isn’t properly warmed up, you might feel uncomfortable a lot quicker than those around you without thyroid problems.

Why does an underactive thyroid cause cold hands and feet?

An underactive thyroid results in a lower production of thyroid hormones, which impairs your body’s ability to produce energy (3). This also means that your body will need a longer time to adjust to colder environments.

When you have hypothyroidism, your body is especially sensitive to low triiodothyronine (T3) levels (4). Lack of thyroid hormones slows down your metabolism and decreases the amount of energy and heat your cells can produce. It takes some time to normalize, even longer than it takes to normalize blood levels of T4 and TSH.

Basal body temperature and hypothyroidism

Most people with an underactive thyroid and Hashimoto’s have a lower basal body temperature (BBT) than average (5). Maintaining your BBT takes a lot of energy and this process is also regulated by your thyroid hormones. So if you have an underactive thyroid, you’ll generally feel colder as you have less thyroid hormones to keep up your BBT. However, with the right treatment your susceptibility to feeling cold should diminish.

If you’re already being treated for an underactive thyroid, cold hands and feet—as well as cold-like symptoms including shivering and a swollen throat—can indicate your thyroid medication dose needs to be adjusted (6). These symptoms can occur when there’s a drop in thyroid hormones.

If you’re experiencing cold hands and feet, talk to your doctor about how to manage these symptoms and decrease your sensitivity to the cold. It’s also helpful to know if your sensitivity improves by changes in your medication or your lifestyle.

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1. D. Carlsson, et al. Can sensation of cold hands predict Raynaud’s phenomenon or paraesthesia, 2018

2. Safer JD. Thyroid hormone action on skin, 2011

3. Al-Adsani H, et al. Resting energy expenditure is sensitive to small dose changes in patients on chronic thyroid hormone replacement, 1997

4. Laurberg P, et al. Cold adaptation and thyroid hormone metabolism, 2005

5. Ljunggren JG, et al. The effect of body temperature on thyroid hormone levels in patients with non-thyroidal illness, 1977

6. Jonklaas J. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement, 2014

Body, SymptomsClar McWeeney