This new paper in Thyroid simply demonstrates why hypothyroidism induces feelings of cold and how thyroid hormone restores the body's ability to produce the internal heat needed to stop feeling cold.
Resolution of Hypothyroidism Restores Cold-Induced Thermogenesis in Humans
Claudia Irene Maushart, Rahel Loeliger, Gani Gashi, Mirjam Christ-Crain, and Matthias Johannes Betz
Published Online:8 Mar 2019 doi.org/10.1089/thy.2018.0436
Thank You so much Diogenes for the Great and Very Informative Post that you so very Graciously Post for our Betterment . It jus confirms to me the article that I read On Thyroid Tired 3/1/17 By Barbara Lougheed the benefits of T4 when feeling cold .
Hi unfortunately link won't open but I think most of us who have been hypo then taken thyroxine could have said this decades ago but I daresay article is about the mechanism? I'll see if I can get back to this later.
liebertpub.com/doi/10.1089/...
Works for me.
Thanks that link opened okay! Not sure that I learned anything new though ..I think most of us who have experienced hypo conditions know how cold you can feel ..I was adding cardigans and jumpers in the heatwave of ‘76, while everyone else was stripping off, due to untreated thyroid. Bit of an example of not listening to or believing in what people say about their condition without some sort of measurement.
Patients often do know things much earlier than researchers and a long time before it gains medical acceptance.
Unfortunately it's a slow road to get things noticed and written up by the right people. But it gives us patients evidence in our back pocket that we can show to medics, family, etc, to back us up.
When I had a frozen shoulder my doctor said it was to do with my thyroid but the hospital endos said it was nothing to do with the thyroid see your doctor!! I went to a thyroid self help group and asked if anyone else experienced this and every hand went up! Now it appears in lists of symptoms.
Yes i’ve had it and a close hypothyroid relative. Many musculoskeletal disorders are more prevalent in those with hypothyroidism. Anyone who says otherwise is not heeding plenty of research into the matter and has no basic grasp of the disorder or how it affects people. It makes one shudder to think supposed experts in endocrinology are so utterly clueless and ill informed.
But this study makes it hard for doctors to claim we are imagining that we feel cold. It has done a good job of some quantification.
I agree that we already know it and it is a shame that it is no longer recognised or acknowledged as a diagnostic symptom of the disorder. They had no such problems when the first effective treatments became available - it was accepted as fact.
One thing I have never had a problem with is with coldness being recognised as a symptom of hypothyroidism. It is one of the basic symptoms in conjunction with other factors such as hair loss and weight gain. My problem was starting from a 7 stone base, putting on half a stone didn’t seem light weight gain to an arrogant doctor. Frozen shoulder is different and was not recognised 40 years ago but now is.
None of my symptoms were ever accepted as hypothyroidism. Even though I asked if they could be and because there was a lot of it in my family it was simply dismissed as menopausal. I had to demand a test in the end. Perhaps the fact I had no goitre and was thin may have influenced the erroneous opinion of the medics.
Ah the menopause ...another excuse to dismiss women! I was in early twenties and had several tests for anaemia though never been anaemic. I’d love to know how and what docs were taught in med school to become so prejudiced and dismissive!?
They just want an easy solution to get you out of the surgery I guess and they use a universal occurrence in women over 40 (usually) to explain problems that sex hormones might reduce! Apparently they are told virtually nothing about the thyroid despite it being a very common cause of disorder especially in menopausal age women and what they are told is pretty poor. TSH must be 10 before treating and don’t even bother with post menopausal women, they are not even worth bothering with as their TSH is massive anyway. Levothyroxine until TSH Number IS somewhere in the range preferably close to the higher values to save their heart and bones from degradation due to T4 overdose - sorted! ....any complaints - those ones are nutters give them antidepressants. Quality, bespoke individual care eh?
Well my long term doc bases things on how I feel not just TSH but different one is concerned about heart and bones and of course not even a whisper of getting T3 now the company producing it increased price by some ridiculous amount. I’d say my docs now are pretty good compared to the original rubbish one whom I know misdiagnosed several other women with different conditions because he knew best. He disappeared pretty quickly from the practice years ago but I noticed still practiced somewhere else.
So pleased you have found a great doc I know they do exist. The one who got me diagnosed was fantastic but I moved and had to leave the practice - he always listened and was just brilliant. I like my current one but avoid going as much as I can! I spent enough time st the docs when my thyroid was going in the blink I seemed to live In doctors surgeries with this problem and that problem. What I get now seems minor stiff that soon resolves 😊
There was a time when the doctors number was used so much it appeared in my ‘Friends and Family’ list! Know what you mean and of course the more times you go without any real diagnosis or treatment the more neurotic you are deemed to be!
I think the niggles are probably thyroid related - I can’t imagine popping pills can ever be as good as when the real gland worked properly and adjusted every moment for any eventuality. It simply cannot be as seemless or precise. Aches and pains in my bones and tendons are what’s giving me gip at the mo I have these horrible lumpy bits in my toes by the joints that rub and can make walking agony they are so small but boy can they pack a punch. I feel a twit to go to doc about it! Also if I even think an MRI scan might be needed I run for the hills i’d Rather die than go in one ever again - it totally freaked me out! The noises and it felt like a hurricane was blowing through my knee plus being trussed up and thinking I might get cramp and not knowing how long and being shunted further into the darn chamber (why not out for psychological reasons alone?) - truly the stuff of nightmares!
People on this site often see everything as thyroid related and give what they think is good advice e.g my bad painful creaking knees. But then my older sister has had both knees replaced, thinks it’s the best thing ever and has never had a thyroid problem.
Oh yes I totally agree that many things can go wrong with a body for many reasons but arthritis is believed to be a precursor to thyroid disorder due to the genetics concerned being closely related. My arthritis started at 23 😳(osteo/spondylitis) and I began to have thyroid symptoms in my 30’s. I guess it did well to resist attack and not conk out for over 30 years! I have bakers cysts in my knees but the pain was much worse when the cysts were deemed too small to warrant an operation (hence my MRI scanner experience 😱) now they are bigger I don’t notice them but they might have something to do with those toe joint swellings and pain of course I am adamant the cysts are thyroid related 😂🤣😂 i think some new knees would be ace! Glad your sister has had such success with hers. In fact I wish I could have a new skeleton but I am pretty happy with my life and can tolerate all the aches and pains
My sister has been pretty well apart from the arthritis but (along with her partner as takes two) may be a carrier as one son has ankolysing spondylitis while he and brother and sister have haemochromatosis and bowel disease. I had thyroid symptoms as a child and teenager and the ballet didn’t help with many times of bandaged knees due to housemaids knee. Gout in big toes in late twenties but that went. Worst is not being able to play guitar now. Things do wear out though my other sister still dances at 73 and no joint probs in legs at 73 lucky thing. Can’t live forever but would be good to be pain free. Luckily are discovering that hip and knee replacements are lasting longer than first though so may not have to wait until in total agony to wait for op. Have a good weekend,
That is interesting if a bit unfortunate about the inherited disorders. All the women down our line have had thyroid disorders of one kind or another. Usually hypothyroidism. I forgot that I had housemaids kneee in my early 20’s, luckily it went away. Hats 🎩 🎩 off to your dancing 💃 sister that is impressive athleticism. I am sorry you cannot play the guitar anymore it is such a beautiful instrument. My poor mum had to give up knitting she got duptchens contracture in her hand that made it impossible to hold needles etc and carry out the fine motor movements required. I suppose listening to music might be some solace. Have you tried golden paste for the pain? There has been good research demonstrating turmeric has strong anti inflammatory action via at least two substances it contains. The pain of arthritis is unspeakable.
I went on a green woodcraft day yesterday and coincidentally discussed turmeric as anti - cancer and helping arthritis and the fact it has to be a concentrated supplement (or there would be very little arthritis or cancer in the Asian continents!) I do buy fresh turmeric but don't have turmeric every day. It so happened there was a man there who had had an operation for the same condition as your mother. I'd never hear of it but his op was quite successful though what we were doing wasn't exactly fine motor skills. (Also turned out he knew my lecturers from 40 years ago - quite a day!) occasionally hands and knees don't seem too bad then it comes back with a vengeance. Am trying to see if weather/diet makes a difference as pretty much cured acid reflux with diet and know that strawberries and beef aren't great for arthritis. Funny old world eh? However medical research is making great strides in many areas so we are lucky. Had to tell a friend off recently for using up her daughter's antibiotics .. Intelligent woman but if she is unaware of superbugs etc what hope the rest!!?
I think the research I read indicated that eating turmeric in food had great benefit for reducing pain. A pal at work is very keen on golden paste even gives it to her horses
and her dog! I keep meaning to make some up but tend to just use turmeric in my food. Margaret Thatcher had duptchens contracture and had it operated on. I theorise that she was hyperthyroid - only sleeping 5 hours a night and never feeling tired, her belligerent/bellicose manner and scary staring eyes, plus the wrist problems! It would not surprise me.
I was hyperthyroid and unfortunately at the beginning stages quite lively and dynamic but just makes you exhausted if not treated. Also had thyroid eye disease after 10 years stable so had major op for ‘big scarey eyes’ (though think that was cartoonists exaggeration and not funny at all when you have it for real)! TED is actually as likely with hypo as hyper and badly treated didn’t help.
I have wondered if I was hyperthyroid initially, at times, when I was younger I was like Mrs T only slept for 5 hours had boundless energy which was nigh on impossible to dissipate it became exhausting to think of new ways to expend it. I might go out for a 70 mile cycle with the club then feel as if I had done nothing and go for a 12 mile run and may be then feel less wired! Sometimes I would feel like screaming as my mind went into creative overdrive with idea after idea pouring out. I kept a note book and would jot them down to try and get stuff out of my head for some relief! I was very driven but did get short bouts of depression and lethargy too. Slowly it reversed so I became more lethargic with sudden hypermanic episodes.
I had awful eye problems double vision, grittiness/dry eyes and deterioration in all aspects of vision I was never diagnosed with TED but still have ptosis (eyelid droop) in one eye and bad blepharitis. Luckily my eyes never expanded or if they did it was not to any noticeable extent but I do have a slight cast which I developed in the later stages. Any eye stuff really frightens me. The thought of any operation on them freaks me out so I admire you for going through a major eye op. Now I always think of Marty Feldman and what poorly treated Graves’ disease did to his eyes (I adored him as a child I remember him as being very funny and he was incredibly popular. I think he was quite bitter about how badly it affected him). My first blood test came back as hyperthyroid but the second was hypothyroid and then my thyroid gland finally gave up the ghost. My genetics have Graves disease markers but not much for hypothyroidism which is interesting. Most of the family are hypothyroid but there is one hyper. I have been pretty lucky to get back to reasonable health considering how long I went undiagnosed but I can’t imagine I am as well as I would have been if it had been properly treated early. I have developed high blood pressure (the angina started in my 30’s) and get a lot of bone/tendon etc gip. But all said and done I am very fortunate.
Oh that throwing T4 at the problem would work for the low body temperatures found, alongside thyroid dysfunction, in Lyme disease, chronic fatigue syndrome etc.
It (T4) warmed me up a bit but only NDT made me stop feeling cold all the time. I still get very annoying temperature vacillations which disappear during a hot summer like last year. I have not found a solution to it. I regard it as better than being an ice maiden but still not ideal.
I had an unplanned-for test, five hours after my dose (of T4 + NDT, to produce a "reasonable" ratio, and avoid having to beg for T3) and my FT3 was 7.0 (range 3.5 - 6.5), so I cut back a smidgeon, with the unwanted outcome of lowering my body temperature. There are some papers (or one, certainly) which concluded that people feel cold without actually being cold, but I experience drops out of the blue to 35.3C, even in the summer. On T4 solely, I got my FT4 to the top of the range but FT4/FT3 was 4.6, which I used as a reason to discuss NDT with my GP. There can be a problem getting antibiotics prescribed if I have an infection yet can't produce a convincing fever, nor an immune response. I'm going to have to cobble together a Sherpa fleece blanket into a nice warm robe!
I haven’t taken my temperature to see what happens to it on a boil in the bag moment then the sudden drop into chills. It must go crazy. Eating often triggers it but I am not diabetic it is called gustatory sweating apparently. I’d be ripping off the Sherpa fleece robe only to throw it back on again! Bit like my duvet 🙄🥵🥶🤯
A really interesting paper. I am always interested in learning a bit more about ATP production and thyroid hormone, and the discussion of this paper gives some really interesting information about this.
From my vaguely remembered biology A-level I'd thought nearly all heat generated in the body was 'waste' from necessary bodily activity like liver function. This paper disabused me of that notion, and explains very clearly that heat generation has 2 main components, basal metabolic rate (which I guess includes some of the normal activity I was thinking of), and specific heat generating processes the body uses, primarily brown adipose tissue turning chemical energy into heat, and maybe a few other small things I didn't understand. This is the Cold Induced Thermogenesis of the title.
It's pretty clear straight away that being hypothyroid impacts both mechanisms. Our metabolisms are well known to be slow, and the thermogenesis actions are dependant on T3, too. This paper takes hypothyroid patients immediately after diagnosis, while they are still hypothyroid, and then again 3 months after they've been said to be euthyroid. At each of the two conditions they have a number of temperature and calorimetry measures taken in a warm room, and then again in a chilly room.
I really enjoyed how detailed this paper is. The method includes so much about every instrument and test performed, and alongside reporting averages and interquartile ranges they also have graphs with each individual participant shown. At some points this gives some humour, as they emphasise that the participants are human - not something we see in every study!
This enormous detail also allows us to see the thyroid panels of the hypothyroid participants as they enter the study, as well as to evaluate how well treated they really are on thyroid hormone. For me this is possibly more interesting than the topic of the study, as it's very interesting to see a cohort of thyroid patients.
This study used a TSH cutoff of 10 for entry to the study, so these people are all strongly hypothyroid by my standards (light to moderate by the standards of the study!). But I was interested to see that the freeT3s were not that low. The average was 4.1 with a range of 2.6-5.6. This is only 0.5 away from the centre of the range! Admittedly this is after some had started treatment, so not all TSH values were 10, some were were a good bit lower by that time, but the median was still 10.88. On the other hand, the freeT4 median is below the reference range, and some were much lower, but the range is wide. Some were far far below the range, and others seem to be mid-range or maybe even higher.
As usual, I guess this shows us that some people are luckier than others in terms of getting a TSH and possibly freeT4 response that will get them a diagnosis. But also, these freeT3s are being maintained at decent levels! I was pretty surprised at how good the freeT3s were, and how the range is pretty narrow in comparison to the TSH and freeT4 scores. It shows that the body really does work to maintain that number. My personal impression is that when we see people struggling to get a diagnosis who turn up on the forums, freeT3 is also often low, but freeT4 and TSH are not as low as this cohort of patients. Again, makes me wonder if those are just the unlucky people, whose numbers don't reflect their illness in the way doctors want to see, even though in terms of symptoms they still suffer.
Looking at the treatment these patients get, I'm a bit disgusted. In sharp contrast to a paper Holyshedballs posted a few days ago where we got beautiful looking T4 monotherapy patients with a lot of biological detail, here we get terribly treated T4 monotherapy patients with a lot of biological detail. I think an excerpt of one of their tables says it all about the conventional treatment of hypothyroid patients, the columns show different TSH, freeT4 and freeT3 values from the two measurement stages (before treatment and once 'euthyroid' after treatment begins), and after each of them a P-value showing how statistically significant the changes are. For TSH and freeT4 there is this blaringly significant ridiculous number, and for freeT3 it's a damp squib, and insignificant. The freeT3 across the 2 measures has effectively not changed at all!! So these patients are being treated for an illness that is basically T3-deficiency, and the treatment hasn't change their T3 at all 
The TSH and freeT4 scores are also not great. The median TSH is 1.73, and the highest one we know about (top of the 3rd quartile) is 3.9. There some very undermedicated people in that group by any definition (if not all of them). This one of those many studies that is comparing very hypo people with somewhat less hypo people.
But the good news is the cohort as a whole does show substantial increases in basal metabolic rate while comfortable in the warm condition, and in their response to cold, as measured by energy expenditure. Interestingly the treated group have a similar if not lower basal temperature. In neither group did the basal temperature reduce when they were in the cold. This makes me wonder if I'm measuring it wrong (I think this is the one thing they don't mention how they measured, but I may have missed it), because mine does tend to drop if I feel freezing.
In both cases and there is a lot of statistical detail given. It would have been very interesting to know how this compares to a healthy control, but it does show us that some T4 therapy is probably an improvement on none at all. Although there is no quality of life or patient experience data here, all we know is the bald fact that more calories were expended. So it is possible that the patients didn't feel any better in the treated group, either in the warm or in their response to cold. My personal experience is that I often feel my muscles and organs are gobbling up extra T3 to do things I am not able to experience. We see this in the forum often when people start T4 and feel more energetic at first, but then the extra hormone seems to get rolled into the body's ordinary metabolic processes and not felt anymore.
I say "probably an improvement" for a reason. The paper doesn't ever explicitly discuss this, or even clearly label the graphs, but it seems that in figure 2 we see a chart where each individual patient is shown, and many many people do not see an improvement. In fact a lot of them have worse basal metabolism, and worse response to cold, and a few are roughly equal in both conditions. I tried to count this on my tiny phone screen, and I think about 6 people do worse on basal metabolism, with a similar number the same or almost the same. This is 12 not improving out of a total of 33. For cold response the picture is perhaps less bad, about 4 do worse. Although it looks like most people stayed quite close to their previous response. In both cases a few lucky ducks had huge improvement, and the depressing story is that a lot of them were the ones doing the best in the untreated condition, too.
A lot of statistics are done with these relationships, and disappintingly a section trying to relate the energy expenditures to actual TSH figures. I felt like this paper was strong on detail and analysis, but weak in following the completely conventional ideas about thyroid treatment 
In the end the later analysis and discussion didn't do much for me, and I feel like it's one of those examples where the most interesting data is given the least interesting analysis and conclusions.
For me the most interesting parts were the introduction that discusses how heat is generated in the body, and the large amount of descriptive statistics in the paper. I hope this lengthy discussion is of use to someone 
Oops, just looked back and seen how massive it is - maybe only useful to me!
I enjoyed reading your discourse and the pertinent points raised. 😊 I have often wondered how I kept going all those years when I must have been hypothyroid I can only think perhaps I maintained enough T3 to function, although I felt cold for decades and had symptoms galore. I was severely hypothyroid when I eventually got a diagnosis and was very ill by then I felt like I was going to freeze to death. Hideous.
Oh no, I had replied to this, but the forum seems to have eaten it! Thanks for your kind words, and its great to know someone has read it!
New paper showing serum thyroid hormone levels and tissue levels are different (in the rat)New paper out showing hypothyroidism on treatment linked to low FT3New paper that does seem to potentially give T3 a role and questions trials of combination therapy to dateAbstract of New Paper - about optimizing diagnosis and treatmentNew paper showing TSH is controlled by both T4 and T3
