Cold intolerance

Cold intolerance means being more sensitive to cold than expected. You may need extra layers when other people feel comfortable, or your hands and feet may take a long time to warm up.

People naturally differ in how they experience temperature. Body size, body fat, activity, age, and the surrounding temperature all play a part. However, new or worsening cold intolerance can sometimes be related to a health condition.

Cold intolerance is not the same as chills. Chills are episodes of shivering that often happen with a fever or infection. Cold intolerance tends to be an ongoing or repeated sensitivity to cool temperatures.

Cold intolerance can affect your whole body or mainly your fingers, toes, ears, or nose. You may notice:

• Needing more clothing or blankets than other people
• Cold hands and feet that warm slowly
• Shivering in mildly cool surroundings
• Discomfort in air-conditioned rooms
• Pale, blue, or red fingers during cold exposure
• Tiredness, weakness, or difficulty concentrating alongside feeling cold

Changes in finger or toe colour may suggest Raynaud's phenomenon. This is a temporary narrowing of small blood vessels, usually triggered by cold or stress. The affected areas may also feel numb, painful, or tingly.

Temperature and body build are frequent explanations. A cool home or workplace, damp clothing, low body weight, recent weight loss, or a low food intake can make it harder for your body to stay warm. Older adults may also produce and retain heat less effectively.

An underactive thyroid, called hypothyroidism, can cause cold intolerance. The thyroid is a gland in your neck that helps control how your body uses energy. Other possible symptoms include tiredness, constipation, dry skin, weight gain, slower thinking, or heavier menstrual periods.

Anaemia means the blood does not carry as much oxygen as it should. Iron deficiency is one cause, but there are others. Anaemia may also cause tiredness, pale skin, headaches, dizziness, breathlessness, or a fast heartbeat.

Raynaud's phenomenon mainly affects the fingers and toes. Episodes are often triggered by cold weather, touching cold objects, or emotional stress. Raynaud's can occur on its own or, less commonly, alongside another condition.

Less common causes include problems affecting circulation or nerves, long-term illness, and disorders involving the pituitary gland, which helps regulate the thyroid. Some medicines can make the hands and feet feel colder. Do not stop a prescribed medicine without medical advice.

Cold exposure can also cause hypothermia, meaning the body's core temperature has fallen dangerously low. This is different from ongoing cold intolerance and requires urgent care.

Call emergency services if cold exposure is followed by confusion, slurred speech, poor coordination, very slow or shallow breathing, or difficulty staying awake. These can be signs of hypothermia. A measured body temperature below 35°C or 95°F is also an emergency.

While waiting for help, move into shelter if it is safe, remove wet clothing, and use dry blankets. Avoid placing very hot objects directly against numb skin.

Seek same-day medical advice if cold intolerance has suddenly become severe or occurs with marked weakness, worsening breathlessness, a racing heartbeat, or significant dizziness. Chest pain, fainting, severe breathing difficulty, or new confusion need emergency care instead.

Book a routine appointment if the symptom lasts for several weeks, keeps getting worse, or affects sleep, work, or usual activities. It is also worth arranging an appointment if you have unexplained weight change, persistent tiredness, constipation, heavy periods, unusual bleeding, hair or skin changes, or repeated painful colour changes in your fingers or toes.

A healthcare professional will ask when the symptom began, whether it affects your whole body, and what temperatures trigger it. They may ask about weight or appetite changes, menstrual bleeding, pregnancy, diet, medicines, previous illnesses, and other symptoms.

An examination may include checking your temperature, pulse, skin, circulation, thyroid area, and signs of anaemia.

Tests are chosen based on your symptoms rather than cold intolerance alone. Common tests may include a complete blood count to look for anaemia and thyroid blood tests. Iron tests, including ferritin, may be useful if iron deficiency is possible. Other testing may be needed if there are signs of a circulation, hormone, or long-term health problem.

Treatment depends on what is causing the symptom. An underactive thyroid is usually treated with prescribed thyroid hormone. Anaemia treatment depends on its type and cause. Raynaud's may improve by reducing cold exposure, although some people need medicine.

Do not start iron, thyroid hormone, or high-dose supplements simply because you feel cold. Too much can be harmful, and treatment may delay finding the actual cause.

For day-to-day comfort:

• Wear several light layers and keep clothing dry
• Use gloves and warm socks before going into the cold
• Eat regular, balanced meals
• Keep gently active when safe
• Warm cold skin gradually rather than using intense direct heat
• Avoid smoking or vaping nicotine, which narrows blood vessels

If a medicine may be contributing, ask the prescribing professional to review it rather than stopping it yourself.

Cold intolerance caused by short-term exposure usually improves after you warm up. Symptoms related to low food intake or recent weight loss may improve as nutrition and weight stabilise.

When an underlying condition is responsible, improvement depends on identifying and treating that condition. Some causes respond over weeks, while Raynaud's may continue to cause episodes that need ongoing prevention. Return for follow-up if symptoms persist despite treatment or if new symptoms develop.

Does cold intolerance always mean a thyroid problem?

No. An underactive thyroid is one possible cause, but body build, the environment, anaemia, circulation changes, diet, and medicines may also contribute. Blood tests are needed to confirm a thyroid disorder.

Can iron deficiency make me feel cold?

It can. Iron is needed to make haemoglobin, the part of red blood cells that carries oxygen. Iron deficiency may cause anaemia, but feeling cold alone does not prove that you are iron deficient.

Why are only my hands and feet cold?

The body reduces blood flow to the skin in cool conditions to protect its core temperature. Raynaud's phenomenon and some circulation or nerve problems can make this response more noticeable.

Should I check my temperature?

A thermometer can help if you feel unwell after cold exposure, but a normal reading does not rule out a cause of ongoing cold intolerance. Seek emergency help for a temperature below 35°C or 95°F, especially with confusion or drowsiness.