Do you notice that you feel particularly unwell in the cold winter months and then start to feel better when the weather warms in spring and summer? You’re not alone.

MYXEDEMA, THE ORIGINAL TERM FOR HYPOTHYROIDISM

The disease we now call hypothyroidism was first termed myxedema (British spelling: myxoedema) in 1878 by British physician William Ord. In his paper titled “On Myxoedema, a term proposed to be applied to an essential condition in the “Cretinoid” Affection occasionally observed in Middle-aged Women”, Ord described a 54-year-old widow.[1]

Her illness had commenced five years before. Up to that time she had been active, and not stouter than average. She had, when first taken ill, been very anxious in connection with the fatal illness of her husband. The first signs of illness were fits of shivering during her work.

~William Ord. 1878.

Feeling cold all the time? It’s not your imagination. Sensitivity to cold has been a hallmark symptom of hypothyroidism ever since Ord’s early recordings.

MYXEDEMA COMA & HYPOTHERMIA

Myxedema is a term used synonymously today with severe hypothyroidism characterized by swelling and thickening of the skin (myx meaning “mucus” & edema meaning “swelling” from ancient Greek).

Myxedema coma, also referred to as myxedema crisis, is a rare life-threatening condition resulting from extreme hypothyroidism. It is a medical emergency. If the condition is not promptly diagnosed and treated, the mortality rate has been reported to be as high as 60%.[2] A number of people who have been through myxedema coma and survived have written to me over the years to tell me their scary accounts of what happened to them when their TSH levels rose sky high, close to 100 and some even higher.

And guess what one thing they all described? A sudden plummeting in body temperature with uncontrollable body chills “like the feeling of being locked in a freezer”, as described by one of my Hypothyroid Mom readers.

SIGNS OF MYXEDEMA COMA

And sure enough severe hypothermia is a key clinical sign of myxedema coma. It can also present with other severe manifestations of hypothyroidism.[3]

Hypothermia

Altered mental status

Hypotension (low blood pressure)

Bradycardia (slow heart rate)

Hypoglycemia (low blood sugar)

Hypoventilation (shallow breathing)

A 47-year-old comatose woman was brought to the emergency room with hypothermia (low body temperature with body chills), dyspnea (shortness of breath), general weakness, along with a drop in heart rate to 58 bpm, drop in blood pressure, hair loss, extreme fatigue, dry skin, weight gain and facial and eyelid edema (swelling). A chest radiography showed cardiomegaly (I’ve written about the enlarged hypothyroid heart in this article here) and bilateral pleural effusion. She had a history of hyperthyroidism and underwent thyroidectomy (thyroid removal surgery) 5 years previously, and she was taking no thyroid medication. Lab results revealed a very high TSH of 90.54.[4]

This case suggests that myxedema coma should be considered in patients with hypothyroidism or a history of thyroidectomy who present with change in consciousness, hypothermia, or other symptoms related to critical or slow presentation in multiple organs. 

Tsai, S., et al. Journal of International Medical Research. 2018.

The key to survival is quick diagnosis and treatment. The problem is whether or not the hospital staff figures things out fast enough. And whether or not we, the patients, are aware of these deadly signs of severe hypothyroidism like severe feeling of cold with body shivers to speak up for ourselves in the emergency room should this ever happen to us. And, if we are in an altered state of consciousness that happens in severe hypothyroidism when admitted, do our families know these signs to alert the hospital staff?

Here’s what has me wondering about this. In 2023, researchers went through the NIS (National Inpatient Sample), the largest publicly available inpatient care database in the United States containing data on millions of hospital stays across the country. Remember that mxedema is a deadly complication of severe hypothyroidism that requires immediate emergency intervention. What they found shocked me. In patients with myxedema coma, admission on weekends (when hospitals operate with reduced staffing while experiencing higher patient volumes) was associated with an 87% increase in odds of dying compared to those admitted on weekdays.[5]

COLD WEATER EXACERBATES HYPOTHYROIDISM SYMPTOMS

Cold intolerance is a common symptom of hypothyroidism. That much is clear. The question now is whether or not this a two-way street. Does exposure to the cold, during the long winter months for example, worsen hypothyroidism symptoms?

Your thyroid is regulated by your pituitary gland, which makes TSH (thyroid-stimulating hormone). When you body requires more thyroid hormone, your pituitary springs into action by increase TSH. TSH then tells your thyroid hormone to make more thyroid hormones T4 and T3.

The thyroid gland plays a crucial role in regulating metabolism and body temperature. When the cold weather sets in, the body tries to generate heat by increasing metabolism to maintain a steady body temperature for survival. This demand for a higher metabolic rate in winter causes your TSH levels to rise to make your thyroid gland work harder to keep your body warm. If your thyroid gland is under-active, however, it may struggle to compensate to make that extra thyroid hormone needed to keep your body warm. If you have no thyroid gland, due to thyroidectomy, radioactive iodine RAI, anti-thyroid medication, or congenital hypothyroidism, then you are completely reliant on your thyroid medication and that same dosage of thyroid medication that you take in the warmer months may not be enough in those cold winter months. As the weather gets colder and your thyroid can’t keep up, and your thyroid medication isn’t adjusted, your symptoms become more and more obvious.

As for the research, not surprisingly, myxedema cases occur most often during the winter months.[6] In the case of an 81-year-old woman with myxedema coma, the patient developed acute cardiopulmonary failure with associated pericardial and pleural effusions.[7]

Myxedema coma is a form of severe hypothyroidism characterized by altered mental status and hypothermia…as well as symptoms that occur as a result of functional decline in multiple organ systems.

Myxedema coma is often precipitated by factors such as cold exposure, myocardial infarction, use of sedatives, infection, or discontinuation of thyroid supplements, or it can also occur as a culmination of severe chronic hypothyroidism. Our reported patient precipitants included discontinuation of thyroid supplements and cold exposure as the patient presented in December in the city of Cleveland, Ohio. 

~AlShanableh, Z., et al. Cureus. 2022.

In 2023, researchers described the effect of seasonal variation in thyroid function results in >7000 healthy Japanese participants. This study showed that in health people TSH peaks highest in the winter months (January-February) in the northern hemisphere and drops lowest in the summer months (June-August).[8] These healthy participants had functioning thyroid glands that were able to increase production of thyroid hormone in those winter months. What about all of us with poorly functioning thyroid glands and those with no thyroid gland at all? Our bodies don’t have fully functioning thyroid glands so we can’t compensate for those seasonal variations on our own. So what do we do?

INCREASED THYROID MEDICATION DOSAGE DURING WINTER MONTHS

Consider this. How many thyroid patients receive the exact same fixed dose of thyroid medication all year long, irrespective of the season and external temperature? With hypothyroidism, our thyroid glands are either under-active or completely missing and, therefore, unable to rev up thyroid hormone production during the winter as needed to keep our bodies warm. Since we can’t rely on our thyroid gland to do this for us, what else can we do? The only way to help our bodies adjust to the winter weather is for our doctors to increase our thyroid medication dosage during those winter months.

When I first started Hypothyroid Mom back in 2012, I was fortunate to have found a great thyroid doctor in New York City who made sure to routinely test my thyroid levels in late fall/early winter and bumped up my thyroid medication dosage to help me get through the winter months. I was fortunate to have a doctor who listened to my symptoms. And he was not the only one. As I met more and more great thyroid doctors through my work at Hypothyroid Mom, I soon realized that many of the them routinely increased their patients’ thyroid hormone replacement medication every winter season. And several of these doctors referred me to this study titled “Is it necessary to adjust the replacement dose of thyroid hormone to the season in patients with hypothyroidism?” that formed the basis for their seasonal thyroid treatment approach.[9]

I was well treated for a decade in New York and then I moved to Toronto, Canada, a few years ago and I realized just how much seasonal changes affect me. The small dosage increase that made me feel perfect through New York winters gave me little relief to manage the colder, harsher Canadian winters. Here I need a substantially higher dosage increase in late fall every year that I take throughout the long months of winter. I share this because these seasonal changes are really dependent on where you live especially in the Northern hemisphere and if you live in a location that has harsher colder winters.

T3 THYROID MEDICATION

In 1900, American expedition doctor Frederick A. Cook described symptoms that his crew experienced during the Antarctic winter of 1898 – depression, irritability, headaches, and insomnia. The term Polar T3 Syndrome was later outlined that linked depression, forgetfulness, cognitive impairment, insomnia, headaches, and mood disturbances to a drop in thyroid hormone T3 among people who spent a prolonged stay in the Antarctic.[10]

The curtain of blackness which has fallen over the outer world of icy desolation has also descended upon the inner world of our souls.

Frederick A. Cook. 1900.

T3 is the active thyroid hormone that binds to the receptors in the cells. In Polar T3 Syndrome, TSH rises and Free T3 levels drop. In the extreme cold, T3 is used up to keep the body warm and the brain is left with a less than adequate supply of the active T3 hormone. This can cause “Antarctic stare”. People describe the feeling as if their mind has gone totally blank.[11] NASA has been studying Polar T3 Syndrome to protect their astronauts from a similar thyroid effect in harsh climates during space travel.

When we are diagnosed with hypothyroidism, levothyroxine medications are prescribed. These medications contain inactive T4 hormone only. It is assumed our bodies, especially our liver, gut and skeletal muscle, will convert that inactive T4 in those pills to the active T3 thyroid hormone that does the job of binding to the cells. Some people feel perfectly well on levothyroxine medications like Synthroid. Their bodies convert T4 to T3 efficiently and they feel great. While the rest of us feel sick on levothyroxine because our bodies just can’t do that T4 to T3 conversion properly.

Here is an article with the T3 and natural desiccated thyroid NDT medication alternatives to know about. If you struggle to find a doctor open to T3 and NDT, consider booking an individual consultation with me. As a bonus, I give every person a list of good thyroid doctors that prescribe T3 and NDT for their area.

There is also a new line of thyroid supplements with this one designed to boost T4 to T3 conversion. Also, studies have shown that the herb Guggul (Commiphora mukul) helps increase T3 levels.[12-13]

INFRARED SAUNA TO WARM UP THE BODY & BOOST T4 TO T3 CONVERSION

The liver is the unsung hero for thyroid health. It is the primary location of that crucial T4 to T3 conversion. Our liver’s primary function is detoxification and the more we reduce toxins in our food, air, water, cookware, food storage containers, cleaning upplies, laundry detergents, mattresses, and beauty products, the more time we give our liver to focus on that precious T4 to T3 conversion.

Over the years one thing has stood out to me time and time again. My Hypothyroid Mom readers rave about infrared saunas for helping them feel better overall. Exposing the body to higher heat to induce sweating is a way to move toxins out through the skin. Supporting the liver is definitely one big reason why I think they are popular, but another reason is that they raise our core body temperature. This gives the thyroid gland a break from working so hard to maintain our body temperature, especially during the winter months.

Because my followers rave about infrared saunas, I organized a big sale with my favorite brand. Save up to $1,400 when you mention Hypothyroid Mom.

If you have the space, I love their large multi-person cabins. They have this infrared sauna cabin called mPulse Smart Sauna that includes red light therapy all in one. A study with 43 women tested red light therapy for chronic autoimmune hypothyroidism and subclinical hypothyroidism. The women who used red light therapy found they were able to significantly reduce their dosage of levothyroxine thyroid hormone replacement medication.[14]

If cost and space are an issue, I love their Solo here.

VITAMIN D & LIGHT THERAPY LAMP

A whopping 92% of autoimmune thyroid patients with Hashimoto’s thyroiditis were found to be Vitamin D deficient.[15]

According to researchers:[16]

The overwhelming amount of evidence points to a correlation between vitamin D deficiency and an increased risk of having or developing hypothyroidism, elevated thyroid antibody titers, and thyroid cancer.

~Ashok, T., et al. Cureus. 2022.

Seasonal Affective Disorder SAD occurs predominantly in the winter season when vitamin D levels in the body are low due to a lack of sunlight. Step one is get your Vitamin D tested. And read this article if you are having a hard time recovering your vitamin D levels with supplementation.

Light therapy is often used for people with SAD to increase their vitamin D levels. The lack of sunlight during the winter months can make anyone sad, tired, and depressed, but it can be especially challenging for those of us with thyroid disease. I use this happy light by my desk for about an hour first thing every morning.

READ NEXT: Practical Ways To Use Your Infrared Sauna To Help Relieve Symptoms of Hypothyroidism

References:

[1] Ord, W.M. On Myxoedema, a term proposed to be applied to an essential condition in the “Cretinoid” Affection occasionally observed in Middle-aged Women. Med Chir Trans. 1878;61:57-78.

[2] Qubti, F., et al. Myxedema Coma: Wake Me When 2020 Ends. Chest Journal. 2021 Oc;160(4):A945.

[3] El Bouazzaoui, F.Z., et al. A fatal case of myxedema coma. International Journal of Clinical Endocrinology and Metabolism. 2019 May 02;5(1):013-015.

[4] Tsai, S., et al. Comatose patient with hypothermia, dyspnea, and general edema in the emergency department: a case report. Journal of International Medical Research. 2018 Aug 15;46(10:):4338-4342.

[5] Francis-Morel, G., et al. Admission over the weekend is associated with increased mortality in patients admitted for myxedema coma: A nationwide analysis. Chest Journal. 2023 Oct;164(4):A1570.

[6] Ono, Y., et al. Clinical characteristics and outcomes of myxedema coma: Analysis of a nation inpatient database in Japan. Journal of Epidemiology. 2017 March;27(3):117-122.

[7] AlShanableh, Z., et al. A Very Uncommon Case of Myxedema Coma: Rediscovery of an Old Presentation. Cureus. 2022 July 23;14(7):e27177.

[8] Yamada, S., et al. Seasonal Variation in Thyroid Function in Over 7,000 Healthy Subjects in an Iodine-sufficient Area and Literature Review. Journal of the Endocrine Society. 2022 June;6(6):bvac054.

[9] Hamada, N., et al. Is it necessary to adjust the replacement dose of thyroid hormone to the season in patients with hypothyroidism? Metabolism. 1984 March;33(3):215-218.

[10] Chengli, X., et al Effect of the Antarctic environment on hormone levels and mood of Chinese expeditioners. International Journal of Circumpolar Health. 2003;62(3):255-267.

[11] Palinkas, L.A., et al. Psychological effects of polar expeditions. Lancet. 2008 Jan 12;371(9607):153-63.

[12] Panda, S., et al. Gugulu (Commiphora mukul) induces triiodothyronine production: Possible involvement of lipid peroxidation. Life Sciences. 1999 August 13;65(12): PL137-PL141.

[13] Panda, S., et al. Guggulu (Commiphora mukul) potentially ameliorates hypothyroidism in female mice. Phytother REs. 2005 Jan;19(1):78-80.

[14] Hofling, D.B., et al. Safety and Efficacy of Low-Level Laser Therapy in Autoimmune Thyroiditis: Long-Term Follow-Up Study. Int J Endocrinol. 2018 Nov 4;2018:8387530.

[15] Tamer, G., et al. Relative vitamin D insufficiency in Hashimoto’s thyroiditis. Thyroid. 2011 Aug;21(8):891-6.