FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER NEEDS FURTHER TESTS TO FIND CAUSE OF COLD INTOLERANCE

Question: My name is Bob. I am cold all of the time. I keep my house at 70 degrees, I wear heavy cotton long pants and socks and I still can’t get warm. My doctor says my circulation is fine. What is the problem here?

Answer: A very common cause of being cold is a relative loss of fat in the subcutaneous layer of the skin. As you get older, the overall volume of subcutaneous fat usually diminishes. However this is not uniform over the entire body. Instead, subcutaneous fat on the face, hands and extremities tends to decrease, while at the same time there may be an increase in areas such as the thighs and abdomen.

Since this fat layer acts as an insulator, those areas of the body that lose subcutaneous fat may become very cold sensitive. In fact, loss of this fat can lead to a general sense of being cold all the time.

Another cause of cold intolerance is hypothyroidism, or an underactive thyroid gland. This condition -- which produces low thyroid hormone levels in the blood -- becomes increasingly common in people over 50. It is also more common in women and in obese people. Hashimoto’s thyroiditis is the most common cause of underactive thyroid. Hashimoto’s is an autoimmune problem, where the body’s immune system attacks the thyroid gland. This damages the thyroid gland and makes it incapable of producing sufficient amounts of thyroid hormone.

In addition to cold intolerance, some of the early symptoms are weakness, constipation, weight gain, bone and muscle pain, depression, brittle nails and hair and pallor. If allowed to continue undiagnosed, hypothyroidism can cause slow speech, dry skin, puffy hand, feet and face, and hoarseness. Are you experiencing any of these? In its most severe manifestation, hypothyroidism can lead to coma and death.

If your doctor hasn’t checked you for hypothyroidism, I’d recommend you return and ask him do so. First, he’ll conduct a physical exam and look for such signs as slow reflexes, pale skin, brittle hair and nails, swelling and slow pulse. If he finds any of these things, he’ll next want to take a blood sample to determine the amount of thyroid hormone and to conduct a complete blood count. In addition to these lab tests, a chest X-ray and a CT scan of the head may be requested. The CT scan is to check for tumors in the pituitary gland. That can sometimes be a cause of a low level of thyroid hormone.

There is no way to prevent hypothyroidism, and it can only be diagnosed by blood tests. In the meantime, you might want to turn up the heat at home a bit, and wear several layers of clothes. If you have hypothyroidism, your doctor will put you on thyroid hormone replacement medication, and you will be fine in a few weeks. If you are cold because you have lost your insulating layer of subcutaneous fat, then wearing warmer clothing may be beneficial.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.

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