Why Lyme Disease Causes Heat and Cold Intolerance
Many patients with Lyme disease describe something they never struggled with before: they suddenly cannot tolerate heat or cold.
Lyme heat and cold intolerance may occur when autonomic dysfunction affects the body’s ability to regulate temperature normally.
Patients may walk into a warm room and suddenly feel flushed, dizzy, or exhausted. Others feel chilled indoors when everyone around them seems comfortable. Some swing from sweating to shivering within minutes, unable to maintain a stable sense of temperature.
This type of temperature dysregulation is one of the more overlooked autonomic symptoms associated with Lyme disease.
For many patients, symptoms begin within weeks or months of infection as the autonomic nervous system becomes less stable in regulating circulation, sweating, and temperature perception.
For more on autonomic symptoms in Lyme disease, see
Autonomic Dysfunction in Lyme Disease.
Understanding Lyme Heat and Cold Intolerance
Temperature regulation depends on the autonomic nervous system and the brain’s temperature-sensing pathways.
When Lyme disease affects these systems through inflammation, neural irritation, or autonomic instability, the body may struggle to interpret temperature signals and respond appropriately.
Disruptions in sweating, circulation, and vascular tone may cause ordinary temperatures to feel unusually intense or uncomfortable.
These overlapping changes help explain why heat and cold intolerance are common in Lyme disease and other post-infectious autonomic conditions.
Heat Intolerance in Lyme Disease
Heat intolerance is often one of the first major changes patients notice.
A hot shower that once felt relaxing suddenly causes dizziness or exhaustion. Warm weather becomes draining. Even stepping into a heated car may provoke an immediate sensation of overheating.
Heat may worsen:
- Fatigue
- Brain fog
- Dizziness
- Palpitations
- Exercise intolerance
This pattern is commonly seen in autonomic dysfunction, where heat becomes a physiologic stressor instead of something the body adapts to normally.
Cold Intolerance in Lyme Disease
Cold intolerance appears in a similar way but in the opposite direction.
Patients may describe a deep chill that lingers even after warming up. Others feel cold indoors without explanation or describe being chilled “to the bone.”
This can occur when temperature perception and circulatory responses become poorly regulated.
The sensation often feels exaggerated, persistent, and out of proportion to the environment.
Temperature Swings in Lyme Disease
Some patients experience both heat and cold intolerance.
They may overheat one moment and shiver the next.
These rapid swings reflect instability in autonomic temperature regulation and are increasingly recognized in post-infectious dysautonomia, including Lyme disease.
Why This Symptom Is Often Misunderstood
Heat and cold intolerance rarely appear on traditional Lyme symptom lists.
Without that context, patients are often told their symptoms stem from:
- Anxiety
- Stress
- Thyroid disease
- Menopause
- Deconditioning
Although these conditions may contribute in some individuals, they do not fully explain sudden and persistent temperature dysregulation that begins after a tick-borne illness.
When other causes have been evaluated, Lyme-related autonomic dysfunction becomes an important clinical consideration.
What Recovery Looks Like
As inflammation decreases and autonomic stability improves, temperature sensitivity often begins to settle.
Patients may notice:
- Fewer heat triggers
- Less severe chills
- Reduced temperature swings
- Improved tolerance of weather changes
Many patients describe this improvement as “getting my thermostat back.”
Recovery patterns like these are also recognized in other forms of post-infectious dysautonomia.
Can Lyme Disease Affect Body Temperature Regulation?
Yes. Lyme disease may contribute to autonomic dysfunction that affects sweating, circulation, vascular tone, and temperature perception, leading to heat or cold intolerance.
Patients frequently feel relief when these symptoms are recognized as part of a broader autonomic pattern rather than dismissed as anxiety alone.
Tracking heat and cold sensitivity over time may also help clinicians evaluate autonomic stability during recovery.
For additional information on dysautonomia, see the
Johns Hopkins overview of autonomic dysfunction.
Clinical Perspective
Heat and cold intolerance in Lyme disease likely reflect autonomic nervous system dysfunction involving temperature perception, circulation, sweating, and physiologic regulation.
Although often overlooked, these symptoms are increasingly recognized in post-infectious dysautonomia and may significantly affect daily functioning and quality of life.
Recognizing temperature dysregulation as part of a broader autonomic pattern may improve both clinical understanding and patient care.
Clinical Takeaway
Lyme disease may contribute to heat intolerance, cold intolerance, and rapid temperature swings by disrupting autonomic and temperature-regulating pathways.
These symptoms are increasingly recognized in post-infectious dysautonomia and may improve gradually as nervous system stability recovers.
References:
- Cheshire WP Jr. Thermoregulatory disorders and autonomic dysfunction. Auton Neurosci. 2016;196:82-92.
- Adler BL, Safirstein J, Brancato A, et al. Dysautonomia following Lyme disease. Front Neurol. 2024;15:1344862.
- Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar. J Am Coll Cardiol. 2019;73(10):1207-1220.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Oh, how I suffer with my body’s thermometer. My poor husband.
I have a question.
How am I able to sit in a far infra red sauna , at 67 degrees centigrade, for 30 minutes and then jump into a cold shower and feel great , and then experience extreme restlessness and irritability when the room temperature is 30 degrees centigrade??
Enjoy your articles.
Thank you for caring.
Margaret
The sensory system is so poorly understood
I used to always be cold. Then when I came down with Lyme Disease I could not tolerate the heat. I almost felt that I could never cool down and I would be in a panic. One day I was walking my dogs around my neighborhood in the winter. It was about 35 degrees and I was in a long sleeve T-shirt. My neighbor stopped me and asked, “Aren’t you cold?” I never thought about it. It felt like it was 65 degrees. I got to the point that I almost moved away from DC’s hot and humid summers because I felt so desperate. I have been in remission for many years now. I find that every summer that goes by, I am tolerating the heat more so and happy I never moved because I do love where I live.
So relieved to read that this is Lyme related. I’ve been miserable in my skin for years! Thank you for the information!
I was bit by a tick a year and 3 months ago. I received antibiotics and felt so sick! I’m experiencing very cold chills and assumed it was flu or my body fighting an infection. I am outside a lot and m finding I was either too hot or too cold. Just resting now. I hope it passes. Also, my heart hums when tested. I use to feel it vibrate at night so much it would wake me up. I thought it was anxiety or fast heart. I saw a heart specialist 4 years ago and he said I’m fine. I’ve never been given Lyme diagnosis just preventative measure. I’m having a lot of right knee problems and assumed it was from a fall. So many variables to think of.
I’ve had Lyme for about 10 years and in the past few years heat/cold intolerance has started to become a major symptom/problem. After about 4 hours in bed I get uncomfortably hot, especially my feet, and have to hang them out the cover. This combines with body itching, runny eyes, tinnitus and waking up.
I know if I just stick it out, after about 2 hours I will then get cold and have to pull on another cover. I then fall asleep again and when I finally get up I am really cold and have to do warm up exercises or I will just keep getting colder. Sometimes I struggle to decide if I’m hot or cold, it often comes with an overall sense of malaise.
autonomic issues typically involve Malaise
Oh yes for many years!
Heat g’ets My heart beating and the pulse get crazy (160). Dissyness. I Can cool My self Down with cold water on the hands or feet. I have to eat/drink also, it helps. W’et sooks or wrist bandage helps
Cold is worse. The body goes completely Down. It Can take 4 hours with Electric pillow/blankets to g’et warm again. The body Can be exhausted for days or weeks. I always have warm clothing in My car, and wool neck warmer, wool wrist warmer, cap, gloves, Scharf etc
Lyme disease can be overlooked as a cause.
I completely know about this issue. I also had a problem by body reacting to temperature . While suffering with lyme symtems I would be very cold in the summer at times even when outside temps were 80 and above , I would have get into a warm tub to warm up. In the winter I would be hot and have take heavy cloths off to cool down. Now after treatment including many supplements and almost four months of doxy twice a day I switched back to normal. I also did not sweat in the summer at all until after treatment. Even in a sauna for getting rid of toxins . Now ten years later I still react to temps as you describe I get very cold quickly under fifty degrees and above 65 I still get sick feeling and very unstable. I was luckl to find ND that understood lyme issues And knew what to do Most MD are useless when it comes to lyme
I’ve had Lyme disease for 20 yrs . they give me 12 hrs to live when I got it .. it’s been a horrible 20 years .. the heat now is making me so sick I feel like hell.. too bad the government made this shit with no cure .. they should have to compensate us all ..