Cold intolerance: thyroid, anemia, chemotherapy and other causes
Cold intolerance is an abnormal sensitivity to cold temperatures. MedlinePlus lists its main causes as anemia, hypothyroidism, blood vessel problems such as Raynaud's, anorexia nervosa, problems with the brain's temperature center and chronic severe illness. Some cancer drugs, notably oxaliplatin, also make people very sensitive to cold. A clinician can usually narrow the cause with an exam and blood tests.
What is cold intolerance?
MedlinePlus defines cold intolerance as an abnormal sensitivity to a cold environment or cold temperatures, and notes that it can be a sign of a problem with metabolism. It is different from simply disliking winter: people with cold intolerance feel cold in settings where others are comfortable, often for months.
It is a symptom, not a diagnosis. The useful work is finding what sits behind it, because most causes are identifiable and many are manageable.
What are the main causes of cold intolerance?
The table groups common causes with the clues that often come with them.
| Cause | Other clues | How it is usually checked |
|---|---|---|
| Hypothyroidism | Fatigue, weight gain, dry skin, thinning hair, slow heart rate | Thyroid blood tests (TSH, T3, T4) |
| Anemia | Fatigue, dizziness, pale skin, shortness of breath | Complete blood count and iron studies |
| Raynaud's and other blood vessel problems | Episodes of white or blue fingers or toes | History, exam, sometimes nailfold capillaroscopy |
| Chemotherapy such as oxaliplatin | Tingling or throat discomfort triggered by cold | Discussion with the cancer care team |
| Anorexia nervosa or very low body weight | Weight loss, low energy | Clinical assessment |
| Hypothalamus problems | Other hormone or brain symptoms | Specialist assessment |
How does hypothyroidism cause cold intolerance?
Thyroid hormone helps set the pace of metabolism, which produces much of the body's heat. When the thyroid is underactive, heat production drops. NIDDK lists trouble tolerating cold among the symptoms of hypothyroidism, alongside fatigue, weight gain, joint and muscle pain, dry skin, thinning hair and a slowed heart rate.
It is common. NIDDK reports that nearly 5 out of 100 Americans ages 12 and older have hypothyroidism, and it is more likely in women and in people over 60. Blood tests identify it, and treatment usually brings symptoms under control.
Can anemia make you feel cold?
Yes. Anemia means the blood carries less oxygen than it should. NHLBI notes that mild or moderate iron-deficiency anemia may cause no symptoms, while more serious anemia can cause tiredness, shortness of breath or chest pain, as well as dizziness, cold hands and feet and pale skin.
NHLBI lists groups at higher risk, including people with heavy menstrual periods, gut conditions such as celiac disease or Crohn's disease, kidney disease, and endurance athletes. A complete blood count is the usual first test.
Why does chemotherapy cause cold sensitivity?
Some chemotherapy drugs affect the nerves. Macmillan Cancer Support explains that oxaliplatin can cause numbness and tingling in the hands and feet (peripheral neuropathy), and that during treatment these symptoms are often made worse by cold. A rarer effect is a throat spasm that may also be worse in cold temperatures.
Macmillan advises keeping warm, avoiding iced drinks, and wearing gloves to handle frozen food or items from the fridge. Symptoms usually improve slowly after treatment ends, though for some people they last longer. Always tell your cancer care team about these symptoms, because they sometimes need to change the drug or the dose.
What other factors can make you sensitive to cold?
MedlinePlus also lists anorexia nervosa, chronic severe illness, general poor health and dysfunction of the hypothalamus, the brain's temperature control center. Very low body weight means less insulation and less stored energy for heat.
Some medicines, including beta blockers, are linked to Raynaud's symptoms, according to Mayo Clinic. If cold sensitivity started with a new prescription, raise it with your prescriber rather than stopping the medicine yourself.
When should you see a doctor about cold intolerance?
MedlinePlus advises contacting a health care provider if you have long-term or extreme intolerance to cold. Talk to your clinician sooner if cold comes with fatigue, weight change, shortness of breath, chest pain, numbness, or fingers and toes that change color or develop sores.
Expect questions about when symptoms started, your diet, your general health and other symptoms. MedlinePlus notes that tests may include a complete blood count, a metabolic panel and thyroid tests.
How can you stay comfortable in the meantime?
Dress in layers, keep the torso and head warm, and carry a spare layer for air-conditioned rooms. Warm meals and drinks help, as does regular movement. If chemotherapy or diabetes has reduced your sensation, be careful with heat sources, keep fabric between any warmer and your skin, and ask your care team what is safe.
Keep a simple symptom diary while you wait for results: note the room temperature, what you were wearing, how long you felt cold and any color changes in your fingers or toes. Patterns in that record often help a clinician decide which tests to order first.
Key takeaways
Cold intolerance is a symptom with identifiable causes, most commonly hypothyroidism and anemia.
Hypothyroidism affects nearly 5 in 100 Americans ages 12 and older, according to NIDDK.
Oxaliplatin and some other cancer drugs can make nerves highly sensitive to cold during treatment.
An exam, blood count, metabolic panel and thyroid tests are common first steps.
Report long-term or extreme cold intolerance to a clinician.
Frequently asked questions
What is the most common cause of cold intolerance?
Hypothyroidism and anemia are among the most common medical causes. Many people who feel cold have no underlying disease, which is why testing is useful.
How long does cold sensitivity last after chemo?
It varies. Macmillan Cancer Support says nerve symptoms from oxaliplatin usually improve slowly after treatment ends, but for some people they continue longer. Your cancer team can advise on your situation.
Can low vitamin or iron levels make you cold?
Iron deficiency can cause anemia, and NHLBI lists cold hands and feet among its symptoms. A blood test can check your levels; do not start supplements without advice.
Is cold intolerance a symptom of MS?
Some people with neurological conditions report temperature sensitivity, though heat sensitivity is more often discussed in MS. If you have MS and new cold symptoms, talk to your neurologist.
What tests check for cold intolerance?
MedlinePlus lists a complete blood count, a comprehensive metabolic panel and thyroid tests such as TSH, T3 and T4. Your clinician may add others based on your symptoms.
Related reading
Sources
Cold intolerance, MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine
Hypothyroidism (Underactive Thyroid), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Iron-Deficiency Anemia, National Heart, Lung, and Blood Institute (NHLBI)
Oxaliplatin, Macmillan Cancer Support
Raynaud's disease: Symptoms and causes, Mayo Clinic
About HEATJAC. HEATJAC is a thermal architecture company founded by an anesthesiologist. We design patented garment systems that capture, conduct and broaden warmth across the body, and we publish this knowledge hub because the science of staying warm should be public. HEATJAC products are not medical devices and are not intended to diagnose, treat, cure or prevent any disease.