Why are hands and feet cold and what tests should be taken?

Hands and feet can get cold in cold weather, after sitting still for a long time, or in a cool room. This is a normal reaction of the body, which tries to preserve heat for internal organs. But if the hands or feet are cold even when warm, often turn pale, numb, hurt, change color, or are combined with fatigue, weakness, or dizziness, it is worth looking for the cause.

Persistently cold hands may not just be a household issue. The Mayo Clinic notes that cold hands can sometimes signal a health problem, especially if the skin changes color. Possible causes include anemia, diabetes, Raynaud's syndrome, and other conditions that affect blood circulation or nerves.

Laboratory tests are not always necessary. But they are helpful when the symptom recurs for no apparent reason, does not go away after warming up, or is accompanied by other changes in well-being. In such cases, it is important to check blood, iron stores, glucose levels, thyroid function, and other indicators as recommended by your doctor.

When cold hands and feet can be a normal reaction

If your hands and feet only get cold in the cold, after a walk in the winter or in a room with a low temperature, this is not always a sign of illness. The blood vessels in the skin narrow, blood flow to the extremities decreases, and the body conserves heat in this way.

There are fewer reasons for alarm if your extremities are cold:

• appears only in cold environments;
• quickly disappears after warming up;
• not accompanied by pain;
• not accompanied by numbness or tingling;
• does not cause discoloration of the fingers;
• does not interfere with walking, working or sleeping;
• not accompanied by weakness, pallor, or shortness of breath.

But if your hands and feet are constantly cold, even when it's warm, or you notice other symptoms, you shouldn't limit yourself to warm socks. This condition may be related to circulation, metabolism, the nervous system, or deficiencies.

When to pay attention to anemia

One common cause of cold hands and feet is anemia, especially iron deficiency anemia. When the body lacks healthy red blood cells or hemoglobin, the tissues receive less oxygen. This can cause weakness, fatigue, dizziness, shortness of breath on exertion, paleness, and chills.

The NHLBI notes that iron deficiency anemia can cause fatigue, shortness of breath, chest pain, pale skin, and cold hands and feet.

Anemia should be suspected if, along with cold extremities, there is:

• constant fatigue;
• pallor;
• dizziness;
• palpitation;
• shortness of breath when climbing stairs;
• brittle nails;
• hair loss;
• heavy menstruation;
• limited nutrition;
• chronic problems with the gastrointestinal tract.

In such a situation, the doctor may advise anemia test, which helps evaluate hemoglobin, red blood cells, ferritin, iron, vitamin B12, folic acid, and other indicators depending on the complaints.

Why is it worth checking your thyroid?

The thyroid gland affects metabolism and how the body uses energy. If it is underactive, a person may be less able to tolerate cold. Hands and feet may become cold more often, and this can be accompanied by fatigue, drowsiness, weight gain, dry skin, constipation, swelling, or hair loss.

MedlinePlus describes cold intolerance as a symptom that can be related to metabolism, particularly hypothyroidism. The American Thyroid Association also notes that people with hypothyroidism may experience cold sensitivity, and TSH is often used as an initial screening test for thyroid function.

It is worth checking the thyroid gland if coldness in the extremities is combined with the following symptoms:

• constant drowsiness;
• weight gain for no apparent reason;
• dry skin;
• swelling;
• hair loss;
• constipation;
• slow heartbeat;
• menstrual cycle disorders;
• decreased mood;
• feeling cold even in a warm room.

In such cases, the doctor may prescribe TSH, free T4, sometimes antibodies to thyroperoxidase or other indicators depending on the situation.

Raynaud's syndrome and finger discoloration

If your fingers don't just freeze, but also turn extremely pale, blue, or red in response to cold or stress, you may have Raynaud's phenomenon. This is when the small blood vessels in your fingers become excessively narrowed, temporarily reducing blood flow to your tissues.

MedlinePlus explains that in Raynaud's phenomenon, cold or strong emotions cause blood vessels to constrict. The fingers are most commonly affected, but the toes, ears, lips, or nose can also be affected.

Raynaud's is characterized by:

• attacks of cold in the fingers;
• change in finger color to white, bluish or red;
• tingling or numbness;
• pain when warming up;
• a clear connection with cold or stress;
• recurrence of attacks.

Raynaud's phenomenon can be primary, when it is not associated with another disease, or secondary, when it occurs in the context of autoimmune, vascular, or other diseases. MedlinePlus notes that secondary Raynaud's can be associated with lupus, scleroderma, rheumatoid arthritis, carpal tunnel syndrome, disorders of the immune system, connective tissue, or arteries.

If there is a pronounced change in finger color, pain, ulcers, skin thickening, or other systemic symptoms, the doctor may prescribe not only basic tests, but also autoimmune markers.

Diabetes and sensory impairment in the feet

Sometimes patients describe not just coldness, but a strange sensation in their feet: cold toes, tingling, burning, numbness, or decreased sensation. This condition may be related to nerves or circulation, particularly in diabetes.

The CDC notes that high blood glucose levels can damage nerves, and diabetic neuropathy can affect the feet, legs, hands, and arms. Nerve damage can also reduce the ability to feel pain, heat, or cold.

It is especially important to get checked if cold feet are combined with:

• numbness;
• tingling;
• burning sensation in the feet;
• poor wound healing;
• frequent urination;
• severe thirst;
• fatigue;
• blurred vision;
• a family history of diabetes.

If there is tingling or loss of sensation along with the cold, it is also useful to pay attention to the material about numbness of fingers and toes, because these symptoms often require a similar diagnostic approach.

Circulatory disorders in the legs

Cold feet may be related to poor blood flow in the lower extremities. This is especially true if one foot is colder than the other, there is pain when walking, cramps in the calves, a decreased pulse in the foot, wounds that do not heal well, or skin changes color.

The NHLBI describes peripheral arterial disease as a condition in which narrowed arteries reduce blood flow to the extremities. Symptoms can include pain, heaviness, or cramping in the legs when walking or climbing stairs, and in severe cases, pain may occur even at rest.

The following may indicate a vascular cause:

• calf pain when walking;
• relief after stopping;
• cold feet even when warm;
• one foot is colder than the other;
• pale or bluish skin;
• slow healing of wounds;
• reduced hair growth on the legs;
• foot pain at night or at rest.

In such cases, blood tests alone may not be enough. The doctor may order a vascular examination, measurement of the ankle-brachial index, ultrasound of the arteries, or other instrumental examinations.

What tests may be needed?

There is no one-size-fits-all test for everyone with cold hands and feet. Your doctor will select the test based on your symptoms, age, medications, underlying medical conditions, lifestyle, and examination results.

This table does not mean that all tests should be taken at once. It shows the main areas of investigation if cold hands and feet are recurring, combined with other symptoms, or have no obvious explanation.

When should you take the tests in the near future?

A routine check-up is appropriate if your hands and feet are often cold, but your overall condition is stable. However, there are situations when it is better not to postpone a consultation.

It is worth seeing a doctor if you have:

• constantly cold hands or feet for no apparent reason;
• discoloration of fingers;
• numbness or tingling;
• pain in the fingers or feet;
• weakness and fatigue;
• pallor;
• shortness of breath during exertion;
• palpitation;
• severe chills throughout the body;
• dry skin and hair loss;
• thirst and frequent urination;
• leg pain when walking;
• poor healing of wounds on the feet;
• only one limb is cold;
• ulcers or cracks on the fingers.

Be especially careful if your fingers turn blue, black, ulcerate, or are in sharp pain. MedlinePlus warns that if you have Raynaud's phenomenon, you should see a doctor if your fingers or toes turn black or the skin becomes damaged.

What can affect frostbite?

In addition to diseases, the sensation of cold can be affected by lifestyle, diet, smoking, medications, and level of physical activity.

Cold hands and feet can be exacerbated by:

• inactivity;
• smoking;
• prolonged sitting;
• malnutrition;
• low body weight;
• stress;
• lack of sleep;
• some blood pressure medications;
• migraine medication;
• stimulant drugs;
• excessive caffeine consumption;
• working with vibrating tools;
• frequent contact with cold.

The Mayo Clinic notes that some medications, including beta-blockers, migraine medications, stimulants, certain anticancer drugs, and some cold remedies, can trigger Raynaud's attacks or increase your reaction to cold.

You should not stop taking prescribed medications on your own. If symptoms appear after starting a new treatment, it is best to discuss this with your doctor.

How to prepare for the examination

Before your consultation, it's a good idea to spend a few days noticing when your hands or feet get cold. This will help your doctor understand the possible cause more quickly.

Write down:

• when the cold appears;
• is there a connection with temperature or stress;
• Does the color of the fingers change?;
• is there numbness, pain, or tingling;
• Do both limbs freeze equally?;
• whether there is weakness, shortness of breath or dizziness;
• Is there pain in the legs when walking?;
• what medications and supplements you take;
• whether there was anemia, diabetes, thyroid disease or vascular problems.

Some blood tests may require fasting blood sugar levels, especially if glucose, lipid profile, or biochemical parameters are being tested at the same time. Medications should not be changed without consulting your doctor.

What not to do yourself

When hands and feet are constantly cold, people often start taking iron, iodine, hormone supplements, or vitamins without testing. This is not always safe and may hide the real cause.

You should not do it yourself:

• take iron supplements without a confirmed deficiency;
• start thyroid hormones;
• ignore the discoloration of the fingers;
• warm your feet with hot water if you have reduced sensitivity;
• blame everything on «poor circulation» without looking into it;
• cancel blood pressure or heart medication;
• postpone treatment for leg pain while walking;
• treat Raynaud's without evaluating possible causes.

If you have diabetes or reduced sensation in your feet, hot baths can be dangerous because you may not feel the burn. In such cases, it is better to choose a safe warm bath and discuss the symptom with your doctor.

FAQ

Do cold hands and feet always mean poor circulation?

No. The cause may not only be in the blood vessels. Hands and feet can become cold due to anemia, hypothyroidism, B12 deficiency, diabetes, Raynaud's phenomenon, stress, low body weight, or due to the effects of medications.

What test should I take first if my hands and feet are cold?

They often start with a complete blood count, ferritin, glucose, glycated hemoglobin, TSH, and free T4. But the exact list depends on the symptoms, so it is better to coordinate it with your doctor.

Can anemia cause cold hands and feet?

Yes. With anemia, tissues may receive less oxygen, so a person is more likely to experience weakness, fatigue, shortness of breath, paleness, and cold extremities. Blood tests and iron metabolism indicators are needed to check.

When to think about Raynaud's syndrome

If your fingers turn very pale, blue, or red in the cold or during stress, or if they become numb or painful when warmed up, you should see a doctor. Sometimes Raynaud's is an independent condition, and sometimes it is associated with autoimmune or vascular diseases.

Can the thyroid gland cause chills?

Yes. With reduced thyroid function, a person may have a lower tolerance to cold. This is often combined with fatigue, drowsiness, dry skin, weight gain, constipation, or hair loss.

When cold feet require urgent evaluation

If one leg suddenly becomes cold, pale, or bluish, or if you experience severe pain, numbness, weakness, ulcers, or black toes, you should seek medical attention without delay.

Hands and feet may freeze due to the cold environment, but constant chills for no apparent reason requires closer evaluation. Tests can help check for anemia, deficiencies, glucose levels, thyroid function, signs of inflammation, and possible autoimmune causes. If the symptom recurs, is accompanied by numbness, discoloration of the fingers, weakness, or pain in the legs when walking, it is best to get tested and get a clear plan of action rather than waiting for the problem to become more severe.

Author: Ulyana Anatolyivna Dzyuba

Director of Medi Lab Plus LLC, a doctor of the highest category. Has over 45 years of practical experience in medicine and laboratory diagnostics. Founder and head of the laboratory since 2007. More details…