Thyroid Function and Cold Intolerance

Low body temperature can be an uncomfortable and painful symptom of hypothyroidism.

 In this article:

• How the thyroid regulates heat
• What is Basal Body Temperature (BBT)?
• What causes cold intolerance?
• Strategies to manage cold intolerance 

The thyroid gland is the body’s equivalent to a home’s thermostat. Heat regulation is one of the critical roles of the thyroid gland. As the body’s thermostat, the thyroid sends signals (hormones) to generate heat from stored energy. When thyroid function is compromised, the body does not receive appropriate signaling to increase heat generation. Thus, for patients living with hypothyroidism, it is common to experience cold intolerance.  

How the thyroid regulates heat

Temperature regulation is one of the most important biological processes our bodies perform. Thermoregulation occurs primarily by thyroid hormones signaling various systems in the body to increase available energy resources. Typically, fat cells store energy. Specifically, brown fat cells play an essential role in converting T4 into the active form of T3. The body requires T3 to produce ATP (adenosine triphosphate), which is the active form of energy that is utilized by cells. ATP is essential for generating heat.  

Increasing body temperature also requires an increased need for oxygen. Consequently, the heart and cardiovascular system must function well to deliver oxygen-rich blood to various systems in the body for heat production. 

What is Basal Body Temperature (BBT)?

Basal body temperature (BBT) is the body’s temperature when it is at rest. Typically, BBT is the lowest temperature your body will experience each day. While thyroid function tests are the primary tool for diagnosing hypothyroidism, BBT may be another way to assess for low thyroid. Indeed, some studies have found that people with symptoms of hypothyroidism may have normal TSH, T3, and T4 levels, but their BBT is lower than average.   

‍

Maintaining BBT is one of the most costly energy processes the body performs. Thyroid hormones regulate and determine how to utilize and expend energy. Therefore, when a person has hypothyroidism, their body is lacking in available energy to regulate temperature.

It is important to note that while thyroid hormones are the primary regulators of body temperature, many other hormones play a role in temperature regulation, too. For example, studies have found that insulin, glucagon, estrogen, progesterone, leptin, ghrelin, and epinephrine can temporarily impact basal body temperature. 

What causes cold intolerance?

People with hypothyroidism suffer from cold intolerance because they do not produce enough thyroid hormone to convert and utilize stored energy effectively. Therefore, there is less energy available to regulate body temperature compared to individuals with normal thyroid hormone levels. Indeed, when people with hypothyroidism experience cold temperatures, their bodies mount defense mechanisms to preserve heat, such as by drawing blood away from the hands and feet. For this reason, people with hypothyroidism are more likely to suffer from hypothermia, which can be life-threatening.

Strategies to manage cold intolerance

If you find that you are always colder than everyone else or you find yourself bundled up when the outside temperature does not warrant winter gear, it may be valuable to test your thyroid function. If your levels are evenly slightly irregular, it can create life-impacting cold intolerance. 

Ahead, a list of suggested strategies to improve the discomfort and pain caused by cold intolerance:

Thyroid medication can help regulate body temperature

If you have hypothyroidism or Hashimoto’s, your body may require synthetic thyroid hormone to operate effectively. With thyroid hormone replacement therapy, your body will be able to use stored energy and convert it to ATP to increase your body temperature. Without thyroid medication, your body lacks the necessary signal to turn up the heat.

The first step to getting thyroid medication is to meet with a thyroid specialist to assess your thyroid levels. Your specialist will be able to determine the appropriate thyroid medication and dosage for you based on your symptoms, medical history, and lab results. Many times, the dose of thyroid medication will need to be adjusted to improve your thyroid function and relieve symptoms of hypothyroidism. 

Some people who live in seasonal environments with colder winters may need to adjust their thyroid medication to counteract the chill outside. It would be best to discuss any changes to thyroid medication with your doctor.

Enhance your sleep

If you have hypothyroidism, your thyroid gland is working overtime to try to maintain homeostasis. The high energy demands required by your thyroid to operate at sub-optimal levels leaves most people with hypothyroidism tired and sluggish. Furthermore, your body may need more rest in colder months to recover from the increased demands of thermogenesis. Try to improve your quality of sleep, as well as increase the number of hours you allow your body to rest.  

Many people with hypothyroidism find they cannot sleep at night because they are so cold. There are specific strategies you may want to try if you have sleep disturbance for cold intolerance: 

• Turn up the thermostat at night to prevent cold intolerance from waking you up.
• Layer on warm pajamas and bedding such as a down comforter and flannel sheets.
• Consider putting a heat pack near you for added warmth. A spouse or a pet can also make an excellent heater.

Avoid unnecessary exposure to cold

Plan your outings ahead of time by checking the weekly weather report. Similarly, turn the thermostat up to get more comfortable. If your place of work is unusually cold, see if you can get a space heater or increase the temperature in your area. You may need to get a note from your doctor to implement these strategies. If you cannot make environmental changes, consider bringing a hot bag that you can heat and place on your back or neck.

Eat healthful foods

Certain foods are considered thermogenic. That is, they create heat when food converts to energy. Thermogenic properties are in certain fruits and legumes, meats, dairy products, and spices. 

It is imperative to monitor your blood glucose as it plays a crucial role in maintaining body heat. Hypoglycemia, or low blood sugar, can further weaken your thyroid. 

Ensure you receive adequate amounts of foundational nutrients, including omega-3’s, and vitamin D. Omega-3’s are in certain fish, nuts, seeds, and dairy products. In winter months, vitamin D from the sun can be hard to come by, so you may need to consider taking supplemental vitamin D. 

‍

Create your own warmth

Soaking your hands and feet in warm water is a beautiful way to heat your entire body. Similarly, hot baths can also do more than increase your body temperature. They help with relaxation, joint pain, and reduce tension and stress.

Finally, make sure to dress for success (and by success, we mean warmth). Wear layers and make sure to keep your head, hands, and feet warm, especially in colder months.

There are many strategies that you can try to take away the pain and discomfort of cold intolerance. However, the most important element in treating your cold intolerance is to manage your hypothyroidism with the best thyroid medication for you. If you find that you are consistently the chillier than every other person in the room and you have other symptoms that may indicate an unhealthy thyroid, meet with your thyroid doctor to get rid of the chill.

Book A Consultation

Resolution of Hypothyroidism Restores Cold-Induced Thermogenesis in Humans

1.
Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA.
2012.
Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid
22:1200–1235 [PubMed] [Google Scholar]

2.
Wolf M, Weigert A, Kreymann G.
1996.
Body composition and energy expenditure in thyroidectomized patients during short-term hypothyroidism and thyrotropin-suppressive thyroxine therapy. Eur J Endocrinol
134:168–173 [PubMed] [Google Scholar]

3.
Al-Adsani H, Hoffer LJ, Silva JE.
1997.
Resting energy expenditure is sensitive to small dose changes in patients on chronic thyroid hormone replacement. J Clin Endocrinol Metab
82:1118–1125 [PubMed] [Google Scholar]

4.
Silva JE.
2003.
The thermogenic effect of thyroid hormone and its clinical implications. Ann Intern Med
139:205–213 [PubMed] [Google Scholar]

5.
Mullur R, Liu YY, Brent GA.
2014.
Thyroid hormone regulation of metabolism. Physiol Rev
94:355–382 [PMC free article] [PubMed] [Google Scholar]

6.
Fedorenko A, Lishko PV, Kirichok Y.
2012.
Mechanism of fatty-acid-dependent UCP1 uncoupling in brown fat mitochondria. Cell
151:400–413 [PMC free article] [PubMed] [Google Scholar]

7.
de Jesus LA, Carvalho SD, Ribeiro MO, Schneider M, Kim SW, Harney JW, Larsen PR, Bianco AC.
2001.
The type 2 iodothyronine deiodinase is essential for adaptive thermogenesis in brown adipose tissue. J Clin Invest
108:1379–1385 [PMC free article] [PubMed] [Google Scholar]

8.
Silva JE, Larsen PR.
1983.
Adrenergic activation of triiodothyronine production in brown adipose tissue. Nature
305:712–713 [PubMed] [Google Scholar]

9.
Wulf A, Harneit A, Kroger M, Kebenko M, Wetzel MG, Weitzel JM.
2008.
T3-mediated expression of PGC-1alpha via a far upstream located thyroid hormone response element. Mol Cell Endocrinol
287:90–95 [PubMed] [Google Scholar]

10.
Ribeiro MO, Bianco SD, Kaneshige M, Schultz JJ, Cheng SY, Bianco AC, Brent GA.
2010.
Expression of uncoupling protein 1 in mouse brown adipose tissue is thyroid hormone receptor-beta isoform specific and required for adaptive thermogenesis. Endocrinology
151:432–440 [PMC free article] [PubMed] [Google Scholar]

11.
Kellogg DL., Jr
2006.
In vivo mechanisms of cutaneous vasodilation and vasoconstriction in humans during thermoregulatory challenges. J Appl Physiol (1985)
100:1709–1718 [PubMed] [Google Scholar]

12.
van Ooijen AM, van Marken Lichtenbelt WD, van Steenhoven AA, Westerterp KR.
2005.
Cold-induced heat production preceding shivering. Br J Nutr
93:387–391 [PubMed] [Google Scholar]

13.
Ribeiro MO, Carvalho SD, Schultz JJ, Chiellini G, Scanlan TS, Bianco AC, Brent GA.
2001.
Thyroid hormone–sympathetic interaction and adaptive thermogenesis are thyroid hormone receptor isoform-specific. J Clin Invest
108:97–105 [PMC free article] [PubMed] [Google Scholar]

14.
Sellers EA, You SS.
1950.
Role of the thyroid in metabolic responses to a cold environment. Am J Physiol
163:81–91 [PubMed] [Google Scholar]

15.
Broeders EP, Vijgen GH, Havekes B, Bouvy ND, Mottaghy FM, Kars M, Schaper NC, Schrauwen P, Brans B, van Marken Lichtenbelt WD.
2016.
Thyroid hormone activates brown adipose tissue and increases non-shivering thermogenesis—a cohort study in a group of thyroid carcinoma patients. PLoS One
11:e0145049. [PMC free article] [PubMed] [Google Scholar]

16.
Gavrila A, Hasselgren PO, Glasgow A, Doyle AN, Lee AJ, Fox P, Gautam S, Hennessey JV, Kolodny GM, Cypess AM.
2017.
Variable cold-induced brown adipose tissue response to thyroid hormone status. Thyroid
27:1–10 [PMC free article] [PubMed] [Google Scholar]

17.
van Marken Lichtenbelt WD, Daanen HA, Wouters L, Fronczek R, Raymann RJ, Severens NM, Van Someren EJ.
2006.
Evaluation of wireless determination of skin temperature using iButtons. Physiol Behav
88:489–497 [PubMed] [Google Scholar]

18.
R Core Team 2017 R: A Language and Environment for Statistical Computing. v3.4.1 R Foundation for Statistical Computing, Vienna, Austria [Google Scholar]

19.
Pinheiro J, Saikat D, Sarkar D.
R Core Team 2017 nlme: Linear and Nonlinear Mixed Effects Models. R package v3.1-131

20.
Yoneshiro T, Matsushita M, Nakae S, Kameya T, Sugie H, Tanaka S, Saito M.
2016.
Brown adipose tissue is involved in the seasonal variation of cold-induced thermogenesis in humans. Am J Physiol Regul Integr Comp Physiol
310:R999–R1009 [PubMed] [Google Scholar]

21.
Bahler L, Deelen JW, Hoekstra JB, Holleman F, Verberne HJ.
2016.
Seasonal influence on stimulated BAT activity in prospective trials: a retrospective analysis of BAT visualized on 18F-FDG PET-CTs and 123I-mIBG SPECT-CTs. J Appl Physiol (1985)
120:1418–1423 [PubMed] [Google Scholar]

22.
Branco M, Ribeiro M, Negrao N, Bianco AC.
1999.
3,5,3′-Triiodothyronine actively stimulates UCP in brown fat under minimal sympathetic activity. Am J Physiol
276:E179–187 [PubMed] [Google Scholar]

23.
Lahesmaa M, Orava J, Schalin-Jantti C, Soinio M, Hannukainen JC, Noponen T, Kirjavainen A, Iida H, Kudomi N, Enerback S, Virtanen KA, Nuutila P.
2014.
Hyperthyroidism increases brown fat metabolism in humans. J Clin Endocrinol Metab
99:E28–35 [PubMed] [Google Scholar]

24.
Warner A, Rahman A, Solsjo P, Gottschling K, Davis B, Vennstrom B, Arner A, Mittag J.
2013.
Inappropriate heat dissipation ignites brown fat thermogenesis in mice with a mutant thyroid hormone receptor alpha1. Proc Natl Acad Sci U S A
110:16241–16246 [PMC free article] [PubMed] [Google Scholar]

25.
Meyer CW, Willershauser M, Jastroch M, Rourke BC, Fromme T, Oelkrug R, Heldmaier G, Klingenspor M.
2010.
Adaptive thermogenesis and thermal conductance in wild-type and UCP1-KO mice. Am J Physiol Regul Integr Comp Physiol
299:R1396–R1406 [PMC free article] [PubMed] [Google Scholar]

26.
Davies TF, Ando T, Lin RY, Tomer Y, Latif R.
2005.
Thyrotropin receptor-associated diseases: from adenomata to Graves disease. J Clin Invest
115:1972–1983 [PMC free article] [PubMed] [Google Scholar]

27.
Endo T, Kobayashi T.
2008.
Thyroid-stimulating hormone receptor in brown adipose tissue is involved in the regulation of thermogenesis. Am J Physiol Endocrinol Metab
295:E514–518 [PubMed] [Google Scholar]

28.
Wagner MS, Morimoto R, Dora JM, Benneman A, Pavan R, Maia AL.
2003.
Hypothyroidism induces type 2 iodothyronine deiodinase expression in mouse heart and testis. J Mol Endocrinol
31:541–550 [PubMed] [Google Scholar]

29.
Murakami M, Kamiya Y, Morimura T, Araki O, Imamura M, Ogiwara T, Mizuma H, Mori M.
2001.
Thyrotropin receptors in brown adipose tissue: thyrotropin stimulates type II iodothyronine deiodinase and uncoupling protein-1 in brown adipocytes. Endocrinology
142:1195–1201 [PubMed] [Google Scholar]

30.
Bianco AC, Salvatore D, Gereben Bz, Berry MJ, Larsen PR.
2002.
Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronine selenodeiodinases. Endocr Rev
23:38–89 [PubMed] [Google Scholar]

31.
Kumar MS, Safa AM, Deodhar SD, Schumacher OP.
1977.
The relationship of thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3) in primary thyroid failure. Am J Clin Pathol
68:747–751 [PubMed] [Google Scholar]

32.
Cannon B, Nedergaard J.
2004.
Brown adipose tissue: function and physiological significance. Physiol Rev
84:277–359 [PubMed] [Google Scholar]

33.
Carvalho SD, Kimura ET, Bianco AC, Silva JE.
1991.
Central role of brown adipose tissue thyroxine 5′-deiodinase on thyroid hormone-dependent thermogenic response to cold. Endocrinology
128:2149–2159 [PubMed] [Google Scholar]

34.
Zaninovich AA, Raices M, Rebagliati I, Ricci C, Hagmuller K.
2002.
Brown fat thermogenesis in cold-acclimated rats is not abolished by the suppression of thyroid function. Am J Physiol Endocrinol Metab
283:E496–502 [PubMed] [Google Scholar]

35.
van Ooijen AM, van Marken Lichtenbelt WD, van Steenhoven AA, Westerterp KR.
2004.
Seasonal changes in metabolic and temperature responses to cold air in humans. Physiol Behav
82:545–553 [PubMed] [Google Scholar]

36.
Senn JR, Maushart CI, Gashi G, Michel R, Lalive d’Epinay M, Vogt R, Becker AS, Müller J, Baláz M, Wolfrum C, Burger IA, Betz MJ.
2018.
Outdoor temperature influences cold induced thermogenesis in humans. Frontiers in Physiology
9:1184. [PMC free article] [PubMed] [Google Scholar]

37.
Jimenez M, Barbatelli G, Allevi R, Cinti S, Seydoux J, Giacobino JP, Muzzin P, Preitner F.
2003.
Beta 3-adrenoceptor knockout in C57BL/6J mice depresses the occurrence of brown adipocytes in white fat. Eur J Biochem
270:699–705 [PubMed] [Google Scholar]

38.
Rosenwald M, Perdikari A, Rulicke T, Wolfrum C.
2013.
Bi-directional interconversion of brite and white adipocytes. Nat Cell Biol
15:659–667 [PubMed] [Google Scholar]

“Cold” and “heat” of the thyroid gland

The thyroid gland is called the “conductor” of the endocrine system. This is the “regulator” on which metabolism, physical and mental development and the course of all vital processes depend. It is clear that dysfunctions of this organ lead to serious disturbances in the overall system of the body.

In Tibetan medicine, all diseases are divided into “cold” and “heat”. Thyroid disease is no exception. “Cold” is a decrease in its functions, namely the production of thyroid hormones T3 and T4 and calcitonin (regulates calcium metabolism). As a result, hypothyroidism develops, in which metabolic processes in the body slow down. Hence the general weakness, chilliness, drowsiness, decreased concentration of attention and mental activity, depression, apathy, etc.

On the other hand, when the thyroid gland is overworked (“fever”), an excess amount of its hormones enters the blood and metabolic processes are excessively accelerated. Irritability, nervousness, tearfulness, tachycardia, finger trembling (tremor), sleep disturbance, weight loss, fatigue, sweating, heat intolerance, bulging eyes appear. This disease is called hyperthyroidism (thyrotoxicosis).

From the point of view of Tibetan medicine, the main causes of “cold” thyroid gland are irrational (“cooling”) nutrition, physical inactivity, external influence of cold and dampness. In this case, hypothyroidism usually develops against the background of overweight. An equally important factor in morbidity is iodine deficiency.

And, finally, the thyroid gland is especially sensitive to negative emotions, in particular, resentment, and to nervous stress, under the influence of which the “heat” disease – hyperthyroidism can occur.

In Tibetan medicine, hyperthyroidism (“hot”) and hypothyroidism (“cold”) are treated by eliminating the imbalance of the Bad-kan (hormonal regulation) and Rlung (nervous system) systems.

For this, methods of both directed (on the thyroid gland) and general (to normalize metabolic processes, restore the balance of the nervous system) action are used.

Treatment of diseases of the thyroid gland is a delicate matter, requiring special skill, knowledge, and sometimes intuition from the doctor. Thoughtless, formulaic application of Tibetan medicine methods in this case is especially unacceptable.

This equally applies to diseases of “cold” and diseases of “heat” (hyperthyroidism, thyrotoxicosis).

The treatment of these diseases begins with establishing contact between the doctor and the patient, clarifying all the circumstances of the disease, individual characteristics of metabolic processes, temperament. Based on these data, certain therapeutic methods of exposure, herbal remedies, nutrition correction are prescribed.

On the other hand, the significance of the role of the thyroid gland, which it plays in the body, allows the treatment of hyperthyroidism and hypothyroidism to eliminate many disorders associated with these diseases in the body.

Thus, there is a complex healing effect. In the treatment of hypothyroidism, the level of cholesterol in the blood decreases, excess weight disappears (with hypothyroidism), working capacity increases, the emotional state improves, emotional lability is eliminated (in the treatment of hyperthyroidism), concomitant gynecological diseases are eliminated, and metabolism is normalized.

Feeling cold: this may be a symptom of hypothyroidism

Colds: when is hypothyroidism?

Between the larynx and the trachea, in the lower anterior part of the neck, is the thyroid gland, an endocrine gland necessary to ensure and maintain good health in our body.

One of its key functions, controlled by the pituitary gland, is the production of hormones that regulate metabolism and thermogenesis, the production of body heat.

When the thyroid gland does not function properly, it can lead to hypothyroidism, a condition in which the amount of thyroid hormone produced is reduced and therefore sensitivity to cold is increased.

Moreover, this perception is often accompanied by other symptoms such as fatigue or general bloating.

What is hypothyroidism?

When the thyroid gland does not work properly, there are two main diseases: hypothyroidism and hyperthyroidism.

Hypothyroidism is characterized by a decrease in the normal production of thyroid hormones.

Reduced synthesis of these hormones adversely affects the function of peripheral organs and tissues.

Thyroid hormones contribute to the development of the nervous system, the functioning of the basal metabolism and the cardiovascular system, the balance of lipid metabolism, and the maintenance of a proper sleep pattern.

Hypothyroidism: symptoms

Symptoms of hypothyroidism vary depending on the age at which the disease occurs, as well as its duration and severity.

Symptoms include

• cold intolerance
• concentration difficulty
• fatigue
• excessive muscle weakness;
• weight gain;
• swelling of the face;
• dry skin.

Other symptoms may develop at the same time, such as:

• constipation;
• slow heartbeat;
• irregular menstrual cycle in women.

Hypothyroidism can also affect mood.

What are the causes of hypothyroidism?

Hypothyroidism can be different.

In some cases, it may be present from birth and therefore be congenital.

In other, more common cases, hypothyroidism develops in adulthood, often as a result of specific triggers such as:

• autoimmune thyroiditis;
• therapies such as radioactive iodine and drugs such as amiodarone;
• surgical removal of the thyroid gland.

Diagnostic tests for hypothyroidism are the same as those for thyroid function (TSH, FT4 and specific autoantibodies) and thyroid ultrasound.

Hypothyroidism: the importance of drug therapy

Hypothyroidism, if not properly treated, can significantly impair a patient’s quality of life.