Cold Hands and Feet with Sluggish Thyroid - Raynaud's?

Raynaud's Syndrome in Thyroid Patients

Portrait of young woman with ?winter? gloves
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A feeling of cold in the hands and/or feet -- or sensitivity to the cold -- is a common complaint in people who have an underactive thyroid, known as hypothyroidism. Typically, if you're a thyroid patient experiencing these symptoms, the cold sensitivity, and cold extremities will decrease significantly after you've received appropriate and optimal treatment for your hypothyroidism. That may include a levothyroxine drug, or levothyroxine plus T3, or a natural desiccated thyroid drug.

But in some thyroid patients, those cold-related symptoms continue. When cold hands and/or feet persist, you should be evaluated for a condition known as Raynaud's syndrome. Raynaud's (sometimes also spelled Reynaud's) is also known as Raynaud's phenomenon. It's an autoimmune disease that involves an interruption in the blood flow to fingers and toes -- and sometimes to nose and ears -- due to spasms in the blood vessels.

An excellent review of the diagnostic tests for Raynaud's is featured in this Guide to Raynaud's.

Some common triggers for Raynaud's include:

  • Going outside during frigid temperatures
  • Holding an iced drink
  • Walking into an air conditioned room
  • Putting your hands in the freezer
  • Putting hands under cold water
  • Emotional stress

During a Raynaud's attack, the affected area typically turns white, and as oxygen fails to reach the extremities, and in some patients, turns blue, and finally, as oxygen comes back into the tissues, red.

 

During an attack, the fingers or toes may feel cold and numb as blood flow to them is interrupted. You may feel tingling or painful throbbing, and the affected area may swell. As the attack ends and blood flow returns, fingers or toes may throb and tingle. Typically, the blood flow to the skin will remain low until the skin is rewarmed.

After warming, it usually takes 15 minutes to recover normal blood flow to the skin, and it may take several hours for symptoms to resolve.

Diagnosing Raynaud's

In addition to evaluation of your symptoms, your doctor may perform a cold stimulation test. In this test, a device that measures temperature is taped to your fingers, and then your hands are put into cold water. the device measures how quickly your fingers warm and return to regular temperature. A slow response can be a sign of Raynaud's. 

Another test that is sometimes done is called nailfold capillaroscopic. A drop of oil is applied to the base of your fingernail, which is then examined under a microscope to identify abnormal arteries that may be a sign of Raynaud's.

Several blood tests are also used to help diagnose Raynaud's, including: 

  • Antinuclear antibody (ANA) -- which looks for antibodies against cell nuclei, which can be a marker of autoimmunity
  • Erythrocyte sedimentation rate (ESR / rate) -- which can detect inflammation

Raynaud's is a condition that can be a standalone disease, but it also frequently shows up as a "secondary" disease alongside other autoimmune diseases, including Hashimoto's disease, Graves' disease, lupus, Sjögren's Syndrome, scleroderma, and rheumatoid arthritis, among others.

Treatments

If you are a thyroid patient with Raynaud's, beyond optimal thyroid treatment, avoiding or minimizing cold exposure is a key way to avoid symptoms. If you are a smoker, you should also stop smoking, as that is known to aggravate symptoms. 

Keeping the body -- and particularly the extremities -- warm is an important preventive measure for Raynaud's. This also includes avoiding rapid and extreme temperature changes. Hats are often recommended, as well as chemical hand or feet warmers in cold temperatures can provide extra protection. 

Wearing gloves before handling cold or frozen items is also recommended. 

Stress management is especially important because stress is a known trigger for Raynaud's. Relaxation or stress management therapies or practices-- such as breathwork or  meditation -- may be helpful to some Raynaud's sufferers. 

For more severe cases, drug treatments can help, but the drugs used may have various side effects. Some of the drug treatments currently being used for Raynaud's include:

  • Calcium channel blockers such as nifedipine (brand names Adalat, Nifedical, and Procardia)
  • Angiotensin II inhibitors i.e., candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan).
  • The antidepressant fluoxetine (Prozac)
  • The vasodilator sildenafil (Viagra)

Sources:

Nielsen SL, et. al. "Myxoedema and Raynaud's phenomenon," Acta Endocrinol. 1982 Sep;101(1):32-4.

Pope, JE. "The diagnosis and treatment of Raynaud's phenomenon: a practical approach." Drugs. 2007;67(4):517-25.

Shagan BP, et. Al. "Raynaud's phenomenon in hypothyroidism." Angiology 1976 Jan;27(1):19-25.

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