Always Cold? Cold Hands, Cold Feet and Low Body Temperature

“Always cold, but my thyroid is fine” is one of the commonest sentences in the stories on this site. Dr. Wilson’s book treats it as two separate symptoms — cold hands and feet, and intolerance of heat or cold — and tells one Raynaud’s story that readers remember. This guide collects what he wrote, plus the counter-intuitive group he describes: people who feel hot all the time and measure low.

Cold hands and feet, and why they matter more than they sound

WS patients often experience cold hands and feet. At first glance this does not seem to be a very disturbing complaint. However, it can be quite troublesome at times. It can be the cause of a great deal of self-consciousness or embarrassment. Several patients that I have seen have stated that they are actually embarrassed and self-conscious to shake people’s hands because of how frequently people will exclaim about the coldness of their hands.

Cold feet seem to be most often disturbing in relation to sleeping with one’s mate. Patient’s spouses will often complain about the coldness of the patient’s feet in spite of many blankets and covers. The coldness sometimes literally jolts the patient’s spouse. Patients themselves often find it very disturbing that their feet feel extremely cold in spite of being dressed warmly, wearing socks, and doing whatever they can to keep their feet warm.

— Cold hands and feet and Raynaud’s Phenomenon, the book

The Raynaud’s case

One of the most severe incidents of this type of complaint that I have seen was in patient who had been diagnosed as having Raynaud’s Phenomenon. Raynaud’s Phenomenon is a condition characterized by vasoconstriction or vessel tightening in response to exposure to cold. It can cause impaired circulation for a period of time resulting in skin color changes. The patient that I had seen, upon exposure to cold, would experience her hands turning blue.

It was recommended that she change her occupation, which was that of a surgical assistant. Because she was an operating room assistant, the cold conditions of the operating rooms aggravated her condition. However, with proper thyroid treatment, her tendency to develop cold hands and to experience the blue discoloration of her arms resolved and it was not necessary for her to change her occupation.

— Cold hands and feet and Raynaud’s Phenomenon, the book

One patient, one physician’s account — the book is a clinician’s book, not a trial, and this site says so throughout.

Heat intolerance, cold intolerance, and “thermostat wars”

The second symptom page is about tolerance rather than temperature, and it contains the observation most people find surprising:

WS sufferers frequently have temperature sensation abnormalities. They will not tolerate temperature extremes very well and often feel extremely uncomfortable in heat, and/or under air conditioning that is a little too cold. Some patients may sweat extremely easily, while others may not sweat at all. Some patients may be convinced that their body temperature runs above normal since they feel hot all the time and sweat easily. These patients are often extremely surprised to find that their body temperature patterns run consistently below normal.

— Heat and/or Cold Intolerance, the book

So “always hot” does not rule this out in his view; the thermometer, not the sensation, is what he goes by. Then the part everyone recognises:

These temperature discomforts can lead to conflicts. I refer to these conflicts as “thermostat wars.” These thermostat wars take place every day around the country, on the job and at home. I am aware of them because I am frequently told of them by patients. One employee will need sweaters to stand the temperatures that are maintained in the office by coworkers, or a person may need to have a fan to keep cool in an office that is seemingly too hot. Frequently, a husband will turn the thermostat down with the wife turning the thermostat up and vice versa.

These body temperature sensation abnormalities and intolerance to temperature extremes and sweating abnormalities frequently resolve with normalization of body temperature patterns with proper thyroid hormone treatment.

— Heat and/or Cold Intolerance, the book

Why the extremities, and why the reading

The book’s explanation of why cold shows up first in hands and feet is an enzyme story, illustrated with a cat:

An interesting example of how this works can be seen in the Siamese Cat. Its coloring depends upon the production of a certain pigment which is the result of a chemical reaction that depends upon a particular enzyme. Since the function of this enzyme depends on its temperature, the chemical reaction will only take place when the temperature is just right. Interestingly, the only places where the temperature is cool enough for the chemical reaction to take place are found in the cat’s extremities.

— Body Function Dependent On Body Temperature, the book

And the reason he wants a daytime oral reading rather than a cold hand as evidence:

Body temperatures are normally lower in the morning, higher in the afternoon, and lower again in the evening. So if the temperatures are low during the day when they’re supposed to be at their highest, that’s better evidence that there’s a problem.

— Frequently Asked Questions

What to do with this

1. Measure, don’t infer. Three oral readings a day, averaged, for several days — the method, and what counts as low.
2. Count the company. Cold hands rarely travel alone in his lists; the 53-symptom checklist is the five-minute version.
3. Raynaud’s has its own workup. Nothing here replaces it; the book describes one patient whose Raynaud’s-type symptoms resolved with thyroid treatment, and no more than that.
4. If the average is low and the pattern fits, ask for a practitioner or bring the book to your own doctor.

Related symptom pages: Sweating Abnormalities, Flushing, Dry Skin; the temperature hub has the articles.

This is a reader’s guide compiled from Dr. Wilson’s published writing; every quotation is his and links to its source. It is not medical advice.