Q. I am a 38-year-old woman who often has chills and feels cold. Sometimes this occurs when eating, but at other times it just happens for no apparent reason. I also seem to be more tired than usual. I have heard this is a symptom of thyroid disease. Should I get this checked out?
A. Chills that are accompanied by fever and sweating may be signs that your body is fighting an infection, while chills without fever may indicate hypoglycemia, anemia, thyroid disorder, anorexia nervosa or another medical concern. As for the relationship to food, it is possible you are having a food allergy, sensitivity or even hypoglycemic response. However, because much more information is needed, you should get a complete medical evaluation.
I would say hypothyroidism is a distinct possibility given your symptoms of chills, cold feeling and fatigue. Since this is a disorder where too little thyroid hormone is produced, it has the potential to affect additional systems in the body. Others affected by this condition also may experience dry skin, weight gain, difficulty with swallowing, deep and hoarse voice, brittle hair (with or without hair loss), carpel tunnel syndrome, constipation, increased menstrual flow, forgetfulness and depression. However, there are several other potential causes of chills and fatigue. These include but aren’t limited to:
Anemia (low blood count, especially common in menstruating women with significant monthly blood loss);
Hypoglycemia (low blood sugar);
Age (the very young or elderly may have more difficulty with body temperature regulation);
Exposure to cool or cold environments without proper protection;
Stress or anxiety;
Poor health or infections such as the common cold, leukemia, lupus, bladder infection, septicemia (blood infection), hepatitis, Menkes disease, decreased immune function and others;
Malnutrition;
Gallstones (chills and sweating, along with pain);
Medications (potential side effects from narcotic pain relievers, beta interferons, others);
Anorexia nervosa (poor nutrition, anemia, very low body weight, fatigue);
Allergic reaction;
Uncontrolled diabetes;
B–vitamin complex deficiency (may increase cold sensitivity).
Prior to your physician visit, it is important to keep a body temperature diary (one to two weeks) of twice daily readings (morning and bedtime, and during times of chills), as well as a food diary to see if there is any relationship between certain types of food and the onset of your chills. And, to better assist your doctor in getting to the cause of your chills, please know the answers to the following questions:
Are your chills accompanied by fever?
Do you only have a cold feeling, or is it accompanied by shaking chills?
How long (seconds, minutes, hours), how often (daily, occasionally) and during what time (daytime, night, no pattern) do the chills occur?
Do the chills follow the ingestion of certain foods or drinks?
Do other symptoms accompany your chills such as muscle aches, cough, night sweats, shortness of breath, frequent urination, trembling hands and racing heart?
Are you currently taking any medications (including supplements or herbal preparations)?
Do you experience heavy bleeding with your menstrual cycles?
What do you typically eat?
What’s your travel history (checking for any exposure to chill-producing diseases such as malaria)?
Do you currently have any known health conditions or eating disorders?
What health conditions run in your family?
After reviewing your health questionnaire and body temperature diary, a complete physical examination would be in order. Particular attention will be made to your heart (listening for murmurs), blood pressure, thyroid gland (checking for nodules or enlargement), skin (for signs of infection), nails (for signs of infection and poor circulation), as well as to blood tests (blood count, blood glucose levels, thyroid function, blood culture if infection suspected) and urine test. When tuberculosis is suspected as a cause of chills, a ppd (skin test), sputum culture and chest X-ray would be performed.
If an eating disorder or related stress or anxiety condition is of concern, a questionnaire such as the Eating Attitudes Test or Eating Disorder Inventory would be recommended. Depending upon the results, a referral to a compassionate and skilled professional with experience in the diagnosis and treatment of these disorders would be encouraged.
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