Coldness and fatigue are not conditions — they are symptoms attributable to multiple causes. Fatigue alone is often associated with lifestyle causes, physical or psychological causes, or a combination of all three.

Fatigue is difficult to define

It presents differently among people. One way fatigue can be described is:

“a sensation of exhaustion during or after usual activities or a feeling of inadequate energy to begin these activities.”

More commonly, isolated episodes of fatigue alone will resolve

A Dutch study showed 3 in 4 doctor appointments for fatigue were isolated episodes not requiring follow-up. The causes of fatigue can range from insignificant or mild to sinister pathology. There may also be no underlying physical cause. But persistent fatigue with other symptoms, such as coldness requires further investigation.

Suspect hypothyroidism

When someone experiences chronic coldness and fatigue at the same time hypothyroidism may be suspected.

According to the American Academy of Family Physicians, cold intolerance and fatigue are the most common symptoms of hypothyroidis 3m

Irregularity in key thyroid processes causes non-specific symptoms

There are various symptoms associated with hypothyroidism affecting all systems in the body. This is because receptors regulated by thyroid hormones are required for many key processes in the body. People with hypothyroidism may experience other symptoms including but not limited to:

• inflammation of the joints • constipation • depression • difficulty concentrating • dry skin • hair thinning or hair loss • cognitive impairment • heavy menstrual bleeding • muscle pain • weakness • weight gain

The severity of these symptoms reflects the severity of disease as well as the length of time the disease has been developing.

Symptoms more common among patient groups

According to the American Academy of Family Physicians particular symptoms are more common depending on your age and sex: • Infants and children: fatigue and failure to thrive • Pre-menopausal women: menstrual irregularities and infertility • Older people: cognitive decline

Symptoms clear up with treatment

Most patients with hypothyroidism will have their symptoms resolve with appropriate treatment that normalizes their thyroid hormone levels.

There are however a small number of patients, mostly women, who will have persistent symptoms including:

• Fatigue • Depressed mood • Weight gain

There may be an alternative explanation for these symptoms and so further investigation is warranted. Stronger medicine in the form of a combination of two thyroid hormones (T3 and T4) is sometimes required for these patients.