Exercise for Thyroid Disorders: Your Ultimate Guide

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If you have a thyroid condition, exercise might be the last thing you feel like doing. But the truth is, exercise delivers numerous benefits that can positively impact your health and quality of life.

If symptoms like fatigue or weight loss/gain are holding you back, it’s important to understand that exercise can actually help you better manage your thyroid-related symptoms.

If your condition is well-managed and you work closely with your endocrinologist, there is no good reason why you can’t participate in a safely structured exercise program.

Therefore, the purpose of this article is to provide you with comprehensive exercise guidelines for managing your thyroid disease, including exercise types, how often, how hard, as well as important safety precautions.

Thyroid anatomy and function

The thyroid is a butterfly-shaped gland near your voice box that produces thyroid hormones which travel in the blood to help regulate your organs, tissues, and a variety of bodily functions.

Your parathyroid glands are attached to the back of your thyroid gland and produces parathyroid hormone that helps regulate your calcium, phosphorus, and vitamin D levels in your bones and blood.

Normal thyroid function is essential for growth, metabolism regulation, reproduction, and neuronal development.

Triiodothyronine (T3) and thyroxine (T4) are your two most important hormones.

They are produced from dietary iodine which you can get from a variety of iodine-containing foods (ref: better health vic) such as:

• Seafood (tuna, cod, shrimp/prawns)
• Seaweed
• Bread made with iodized salt
• Dairy products (milk)
• Iodized salt
• Eggs
• Prunes
• Lima Beans

If your dietary iodine intake is too low, you may need to consult your endocrinologist to determine if supplementation is right for you.

While iodine nutrition plays a key role in thyroid disease risk, a number of other factors play a role as well, such as aging, smoking, ethnicity, genes, and endocrine disruptors.

Thyroid disorders

We’ve established that your thyroid gland secretes hormones that regulate a number of important biological processes.

But what happens when things go awry and your body produces too much or too little thyroid hormones?

Here we’ll discuss the different types of thyroid disorders and common symptoms.

If you think you might have a thyroid disorder, do NOT self-diagnose. See your doctor for a thorough work-up and evaluation.

Some of the symptoms associated with thyroid conditions can be similar to those of other diseases, so you’ll want to know for certain and confirm it’s not something more sinister like cancer.

Hypothyroidism

Hypothyroidism (hypo = low) occurs when your thyroid gland does not produce enough thyroid hormones.

In the early stages, you might not experience noticeable symptoms, but when they do appear, they may manifest in any number of ways.

Hypothyroidism is not a one-size-fits-all condition and can vary from one person to another.

The condition may come on slowly in some people and quickly in others.

As a general rule, the lower the thyroid levels, the more severe your symptoms might be.

Hypothyroid symptoms may include:

• Weight gain, obesity
• Fatigue
• Low energy
• Loss of appetite
• Muscle pain, weakness, stiffness
• Joint pain, stiffness, swelling
• Depression
• Reduced sweating
• Dry, flaky skin
• Flaky, brittle nails
• Hair thinning
• Difficulty concentrating
• Memory impairment
• Slowed digestion
• Constipation
• Slowed speech
• Slowed movement
• Cold intolerance
• High blood pressure
• Elevated total cholesterol
• Elevated LDL cholesterol
• Menstrual cycle irregularities
• Balance problems

If you have symptoms and suspect you might have low thyroid function, contact your endocrinologist for a proper consultation and diagnosis. Do not attempt to self-diagnose and self-treat.

There are many dubious purveyors of quack thyroid pills and potions on the internet that have potential to harm.

Hyperthyroidism

Hyperthyroidism (hyper = high) occurs when your thyroid gland becomes overactive and produces more thyroxine hormone than your body needs.

The cause of hyperthyroidism may include nodular thryoid disease, inflammation of your thyroid gland (thyroiditis), or Graves’ disease (an autoimmune disorder).

It tends to occur more often in women and those with a family history of Graves’ disease.

Because your body is producing too much thyroid hormone, hyperthyroidism puts your metabolism in an accelerated state.

Therefore, many of the symptoms you may experience are related to your increased metabolism.

Hyperthyroidism symptoms may include:

• Anxiety
• Irritability
• Nervousness
• Increased emotions
• Tremors
• Muscle weakness
• Elevated libido
• Increased heart rate
• Heart palpitations
• Excessive sweating
• Intolerance to heat
• Fatigue
• Interrupted sleeping
• Weight loss
• Menstrual cycle irregularities
• Fertility issues, difficulty getting pregnant
• Diarrhea
• Hair thinning, loss
• Shortness of breath
• Double vision
• Enlarged thyroid gland

If you suspect that you may have hyperthyroidism, contact your doctor for a referral to an endocrinologist for a proper work-up and diagnosis.

Hyperparathyroidism

Hyperparathyroidism (hyper = high) is a condition where your parathyroid glands become overactive and secrete too much parathyroid hormone which can result in high calcium levels in your blood (hypercalcemia).

In a lot of cases, people with mild hyperparathyroidism do not exhibit any symptoms.

However, as the condition progresses and becomes more pronounced, symptoms may include:

• Fatigue
• Muscle weakness
• Depression
• Aches and pains
• Difficulty concentrating
• Loss of appetite

If you suspect you may have hyperparathyroidsim, contact your doctor for a referral to an endocrinologist for a thorough work-up and diagnosis.

Rationale for exercise

There is very limited scientific research surrounding the impact of exercise training on thyroid and parathyroid disease and specific exercise guidelines have yet to be established.

Studies in healthy, well-trained male athletes have shown that high intensity exercise can increase (Ciloglu et al 2005) or decrease (Hackney & Dobridge 2009) levels of circulating thyroid hormones.

Though these reports offer conflicting results, it is important to remember that these findings may not apply to individuals with diagnosed thyroid dysfunction who may suffer from other health conditions that might influence hormone levels.

There is also limited evidence on the impact of exercise on parathyroid function.

Two earlier studies showed that a single bout of aerobic exercise in apparently healthy women (Thorsen et al 1997) and long-term moderate endurance exercise in men (Ljunghall et al 1986) resulted in increased levels of parathyroid hormone up to 72 hours after exercise.

Hyperparathyroidism results in increased levels of circulating parathyroid hormone and exercise may induce an additive effect on this hormone that may further raise calcium levels and impact upon bone metabolism.

Bouts of tachycardia (abnormally elevated heart rate) have also been observed in hyperparathyroidism (Chang et al, 2000), so clearly this condition must be medically managed prior to engaging in structured exercise.

Exercise benefits for thyroid disorders

While thyroid disorders can cause symptoms that discourage you from wanting to exercise, it’s actually exercise that can help you relieve and better manage your symptoms so that you’ll want to be more physically active.

No matter what your thyroid condition, exercise can deliver a multitude of health and quality of life benefits.

Benefits of exercise for thyroid conditions include:

Increased energy levels

If you have hypothyroidism, exercise can help you fight fatigue and give you more pep in your step. The great thing about exercise is that there are a LOT of options available to you and you can find a type of exercise that you enjoy and are likely to stick with for the long-haul.

Boost your mood

Depression often goes hand in hand with hypothyroidism and hyperparathyroidism and can make it feel like you’re towing an anchor through life.

But exercise is known to be a natural and potent mood booster.

In fact, research shows exercise has documented mental health benefits that show it to be on par or even superior to some pharmaceutical medications.

Reduce anxiety

Hyperthyroidism can result in anxiety and jitteriness, but exercise can help you burn off that nervous tension, resulting in a more relaxed and calm you.

Weight loss, metabolism boost

Hypothyroidism can bog down your body and make you feel sluggish, causing you to gain weight.

Exercise, in conjunction with proper medical management, can counter the weight gain and fatigue to help increase your metabolism, boost calorie burn, and help you lose stored body fat.

Decrease joint pain

Hypothyroidism can contribute to weight gain which can, in turn, contribute to extra load on your joints.

If you’re experiencing joint discomfort, you might not feel like moving. Counterintuitive as it may sound, a bit of movement can actually help!

Exercise, along with a healthy diet and proper management of your thyroid condition, not only helps you manage your body weight but can help reduce joint pain and make your day to day activities more comfortable.

Sleep better

If you have hyperthyroidism, the accelerated feeling you may have can cut into your normal sleep cycle and result in poor sleep and a tired feeling during the day. If you have thyroid-related obesity, this can contribute to sleep apnea. Regular exercise, along with proper medical management, can help you get a good night’s rest.

Increased bone density

Hyperthyroidism may result in bone loss, but exercise (strength training in particular) can counteract this effect and help you stem the loss, maintain, or even gain back bone density.

Increase muscle mass

Fatigue and lethargy from hypothyroidism can contribute to lower activity levels and reduced muscle mass. Following on from above, strength training exercise can help counter the loss of valuable metabolism-stoking muscle.

Reduce heart disease risk

Thyroid disorders can increase cardiac risk, but exercise is a potent antidote. I’ve worked with a lot of patients in cardiac rehabilitation who also presented with thyroid disorders and, without a doubt, exercise not only helped increase energy levels, but it helped to effectively manage a lot of the risk factors that increased cardiac disease risk (i.e., body weight, blood pressure, blood sugar levels, etc).

Pre-exercise precautions

If you have thryroid disease, your ability to safely undertake an exercise regimen will depend on your individual health status.

If your thyroid condition is well-managed, then you should be able to engage in exercise the same way that anyone without a thyroid disorder would.

While exercise is known to provide a multitude of benefits, if you have any health issues that could make exercise dangerous (called contraindications), then the risk might be greater than the reward.

Therefore, it’s important to visit your doctor to discuss your medical history and your desire to exercise.

Be sure to obtain medical clearance for exercise. This will give you peace of mind and confidence that you can exercise safely.

Consider hiring a clinical exercise physiologist to guide you in the early stages and put you on the right path forward.

Work with a registered dietitian to help you choose healthy foods that will complement your exercise and lifestyle changes.

Maintain close contact with your medical management team and be sure to report any signs or symptoms to ensure that exercise remains safe for you on an ongoing basis.

Exercise guidelines for thyroid disorders

According to the World Health Organisation’s guidelines on physical activity and exercise, you should:

• Perform 150 minutes of moderate-intensity aerobic physical activity throughout the week (30 minutes of activity 5 days per week) or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity
• Perform aerobic activity in bouts of at least 10 minutes duration
• For additional health benefits, increase your moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity
• Perform muscle-strengthening activities involving major muscle groups on 2 or more days a week

No matter what your thyroid condition, your symptoms might make the idea of exercise seem like climbing Mt Everest.

In this section, we’ll discuss the different types of exercise for thyroid conditions and how you can engage in physical activity as safely as possible.

Aerobic exercise

Aerobic exercise is a type of exercise that uses the large muscles of the body, is rhythmic and/or repetitive in nature, and is performed at a sustainable sub-maximal level (i.e., breathing heavier, but not gasping for air as in anaerobic exercise).

If you haven’t exercised in a long time, you may want to take it slow, choosing no- or low-impact exercises to start with in order to let your body gradually adjust.

If you’re experiencing joint pain or muscle pain, then choose an aerobic exercise that is low-impact, non-jarring, and light on your joints.

Types of aerobic exercise

Walking

Walking is one of the most universal exercises.

It costs nothing, can be done virtually anywhere, and delivers numerous health benefits that help you get fit and fight off disease.

Walking is generally low impact, but if you feel discomfort, you can adjust the intensity or opt for other types of no-impact exercise (discussed below).

Hiking, trail walking

If walking on level ground isn’t enough of a challenge, you can up your walking game with hiking or trail walking.

This type of activity provides more variation in terrain which will further challenge your muscles and cardiovascular system beyond walking on flat city streets.

Bicycle, indoor cycling (no jarring)

If walking is too jarring on your joints, a bicycle (regular bike or indoor stationary bike) can provide you with a lower impact workout.

The circular nature of the movement reduces the vertical jarring of walking and being seated also reduces load on your hips, knees, and ankles.

Elliptical trainer

The elliptical trainer falls somewhere between walking and cycling.

If you find that walking is too jarring but cycling isn’t quite enough of a workout, then an elliptical trainer might just hit the happy medium.

Stair climbing (machine or stairs)

Stair climbing is an excellent exercise that works all the large muscles of the lower body.

The vertical component adds a degree of difficulty that makes it harder than walking, cycling, or riding the elliptical trainer.

If your joints are in good shape and you can tolerate the higher intensities, then stair climbing will deliver a lot of bang for the buck.

Water aerobics

Water aerobics provides a physical workout in a safe, suspended aquatic environment.

The water itself can provide a bit of resistance which adds to the workout, but simultaneously provides support and stability (particularly if you have balance issues).

Classes are often run as groups in community pools and gyms and are led by a qualified instructor.

Swimming

Swimming laps is an excellent way to challenge all the muscles of your upper (the stroke) and lower body (kicking) in a warm aquatic environment.

If the jarring of land exercises is painful, then swimming (or water aerobics) can be the perfect substitute.

Check into swimming clubs in your area which can help you with your swimming technique and breathing.

Dancing

Dancing provides both a physical workout and is a LOT of fun.

If you want to learn to dance, you can enroll in community dance classes.

Many dance groups have a few social dances each week so you can practice what you’ve learned.

Or if you already know how to cut a rug, hit the town and boogie down til the sun comes up!

Cross-training

You don’t necessarily have to do the same exercise every day.

You can mix and match different exercise types on the same day or on alternate days to stave off boredom and provide some variety in your routine.

Frequency (how often)

Frequency refers to how often or how many times per week you should exercise.

Start out with 3 or 4 days per week, or every other day (and work up to 5+ days per week).

Pay attention to how your body feels. If you feel like the first day of exercise smashed you, then take an extra day to recover.

This will give your body time in between workouts to rest, recover, and gradually adjust to exercise.

While you might have high levels of motivation to get fit and healthy, sometimes that can work against you if you do too much too soon.

Remember, exercise is the stimulus for change but the improvements come when your body is recovering between exercise days.

Intensity (how hard)

Intensity refers to how hard you’re working during exercise (also referred to as effort).

If you’re just starting out (or it’s been a while since you last exercised), err on the side of caution and keep your intensity on the lower side for the first week or two.

This will allow your body time to safely and gradually adapt to exercise.

As your body gets accustomed to exercise, you can gradually increase your intensity.

There are several ways that you can quantify your exercise intensity:

• Heart rate calculations
• Heart rate reserve calculation
• The talk test
• The Borg rating of perceived exertion (RPE) scale

Heart rate method 1: Straight heart rate calculation

1) Determine your theoretical max heart rate by subtracting your age from 220.  So if you’re 50 years old, then: 220 – 50 = 170 bpm

If you have an actual MEASURED max heart rate from a stress test, then use that number instead.

2) Then calculate exercising heart rate percentages based on 170 bpm.  

So if you wanted to exercise at, say, 50 to 65% of your maximum heart rate, you’d calculate it as:

170 x .50 = 85 bpm
170 x .65 = 111 bpm.

Therefore your training heart rate range would be 85 – 111 bpm.

For 60 to 75%, it would be:

170 x .60 = 102 bpm
170 x .75 = 128 bpm

Therefore your training heart rate range would be 102 – 128 bpm.

Heart rate method 2: Karvonen method (also called heart rate reserve)

The Karvonen or heart rate reserve method is a little trickier but I’ll do my best to make it clarify.

1) As above, subtract your age from 220 to get your theoretical max heart rate.  

So if you’re 50 years old, it’s 220 – 50 = 170.

2) Then subtract your resting heart rate from the result of step 1.  So 170 – 60 = 110.

3) Now calculate your training heart rate percentages from this.  

If we use the 60 – 75% range it would be calculated as follows:

110 x .60 = 66
110 x .75 = 83

4) Now add your resting heart rate to these numbers.  So:

66 + 60 = 126 bpm
83 + 60 = 143 bpm

Therefore, your exercise heart rate range would be 126 to 143 bpm.

I would advise starting at the lower percentages and see how you go.  

It’s not a perfect science so you may need to adjust the percentages if the training ranges are too easy.

For example, if you’re starting out, shoot for a range between 50 to 65%. If that feels too light, then try 60 to 75%.

As you become more fit, you can gradually work to the higher intensities.

If you have a hard time finding your pulse, use a heart rate monitor or a Fitbit (which also tracks your non-exercise movement habits).

The talk test

If you’re taking medications that alter your heart rate (i.e., beta-blockers), then these calculations are not going to help much.

In that case, you’ll need to rely on what exercise physiologists call the “talk test.”  

If you can have a conversation with the person next to you while doing your exercise, then the intensity is probably sufficient.

The Borg Rating of Perceived Exertion (RPE)

The Borg rating of perceived exertion (RPE) 6 to 20 point scale is also quite useful.  

The logic behind a 6 to 20 scale is that most people at rest or doing light activity have a heart rate between 60 to 90 bpm.  

If you’re working very hard, then you’re going to be around 170 to 200.  

So Borg decided to just drop the zeros and create a scale which is consistent with most heart rates at a given workload.  

This is particularly useful if you’re taking medications that slow your heart rate.  

There is a bit of a learning curve to it, but the more you use the RPE scale, the more in tune you get with your body and your effort level.

Duration (how long)

Duration refers to how long you’re exercising, or exercise time.

Aim to meet the recommended 30 minutes of physical activity per day.

If this is too much, then start off with 10 to 20 minute exercise bouts and work up from there. If this is too much, start at 5 to 10 minutes.

No matter what your level, just start off doing what you can do. Take note of that duration and then try to match it or go a little further the next time.

Pay attention to how you feel both immediately after exercise and the following day.  

Resistance exercise

Thyroid conditions like hypothyroidism can slow down your metabolism and lead to weight gain, which can, in turn, contribute to other weight-related issues like diabetes and heart disease.

Resistance training, also referred to as strength training or weight training, helps build valuable metabolism-stoking muscle that can help keep weight off and protect you against obesity-related diseases.

Stronger muscles will also help reduce muscle and joint pain which can improve your quality of life.

Sample resistance training routine

Start off with a basic whole body routine that works all major muscles of your body from largest to smallest:

• Legs/hips (i.e., squats, lunges)
• Back (i.e., pulldowns, rows)
• Chest (i.e., bench press)
• Shoulders (i.e., overhead press)
• Arms (i.e., biceps curls, tricep presses)
• Abs (i.e., planks, crunches, sit-ups)

Types of resistance exercise

Weight machines

Weight machines provide guided resistance through a specific range of motion. They tend to be safe if used properly and can be a great option if you’re new to strength training. As a fitness instructor to give you some guidance on how to use the equipment.

Free weights

Free weights include barbells and dumbbells. They require more skill and stabilization to carry out the movement. Once you feel comfortable using weight machines, you might want to graduate to free weights.

Body weight

Body weight exercises (sometimes referred to as calisthenics) include movements such as push-ups and sit-ups. The great thing about body weight exercises is that it’s free and you can take it with you anywhere you go.

Resistance bands

Resistance bands, also called elastic bands or therabands, are rubber bands or straps that you wrap around a fixed object to create resistance (i.e., wrapped around a fixed object and performing a rowing movement or biceps curl).

Frequency

Starting out, you’ll want to perform strength training exercises a minimum of twice per week. As you adapt, you can work up to three or four times per week.

Leave a day in between workouts to allow your muscles to recover and grow stronger.

Pay attention to how you feel after the first several sessions. If you’re still sore after 48 hours, give yourself one more day to rest before the next workout.

Intensity

Perform your lifts at a moderate intensity. You should feel fatigued in the window of 8 to 12 repetitions. If you can barely lift a weight once or twice, it’s too heavy. If you can lift it 100 times without much effort, it’s too light.

Once you’ve done a couple sessions, you’ll have an idea of which weights fall into the moderate intensity. As the weights get easier to lift, increase the weight by 5%.

As you become stronger and more skilled, you can work up to higher intensities for multiple sets (1 set is a group of 8 to 12 repetitions).

Duration

Duration in the context of weight training may refer to:

• how long it takes you to perform one repetition of an exercise
• how long it takes you to perform one set of an exercise
• how long it takes you to perform multiple sets of an exercise
• how long your entire exercise session is

Depending on you specific goals, your duration in all these contexts will vary. As a general rule, keep your movements under control at all times. Control the lift on both the up and down phase (with and against gravity).

You might like to start out with one set if you’re new to exercise and graduate onto multiple sets per exercise as you become stronger and more advanced.

Work with a clinical exercise physiologist who is familiar with thyroid conditions and can put you on a safe and effective resistance training program.

Flexibility exercise

Flexibility training is a nice complement to your aerobic and resistance training program. While it’s important to build muscular and cardiovascular strength and endurance, so too is it important to keep your muscles flexible and ready for action.

A lot of fitness centers and community exercise groups offer stretching classes which you can add to your regimen. If yoga is your thing, then by all means give it a go.

Thyroid effects on exercise capacity

Thyroid Dysfunction

Low energy levels

Radioactive iodine or anti-thyroid medications such as methimazole or propylthiouracil are common treatments for hyperthyroidism and may leave you feeling lethargic. 

In the case of hypothyroidism, even if  medicated, you may also experience early onset fatigue.

Pay attention for changes in your energy levels, as this may warrant a reduction in exercise workload or resistance.

Blunted heart rate response

Hyperthyroidism may be treated with beta-blocker medications, which can blunt the heart rate response. 

Therefore, heart rate may not be an accurate indicator of the exercise intensity and rating of perceived exertion may be a sufficient alternative.

Obesity and weight gain

If you have hypothyroidism in the setting of obesity, work towards weight loss and enhanced energy levels. 

Treatment for hyperthyroidism may plausibly lead to a reduction in energy expenditure and weight gain.

It may be necessary to make modifications in exercise frequency, intensity, duration, or modality to accommodate your level of deconditioning or larger body frame (if obese).

Cardiac considerations

Levothyroxine is commonly prescribed for hypothyroidism and may cause tachycardia, palpitations, arrhythmias, and increased blood pressure. E

xercise causes an expected rise in heart rate and blood pressure and the medication may exacerbate the response.

You should diligently monitor both of these parameters before, during, and after exercise and report all adverse events to your doctor.

Other health conditions

Thyroid dysfunction may present in the setting of other comorbid conditions such as diabetes, hypertension, or altered blood lipids.

You may need to monitor additional parameters (i.e., blood sugar, blood pressure, or side effects to dyslipidaemia medications).

Parathyroid Dysfunction

Bone and joint pain

Hyperparathyroidism may promote bone loss due to its effects on calcium status. 

Once treatment has been initiated for this condition, weight bearing exercise may help stimulate bone growth and strength.    

Monitor for signs and symptoms of discomfort in the bones or joints, which may be residual effects from the condition.

Weakness and compromised balance

Pay attention to the possibility of compromised balance if you’ve experienced significant bone loss and fatigue.

Calcium levels

Hyperparathyroidism essentially starves the bones of calcium. 

Though surgical treatment of the parathyroid gland should improve this condition, in some cases, it may result in chronic low calcium levels. 

It is advisable to work in partnership with your doctor in monitoring calcium and vitamin D levels and the extent to which these levels may impact upon your exercise capacity (particularly resistance training).

Comorbidities

As with thyroid disease, you should apprise yourself of any other accompanying health conditions or medications, which may impact your ability to perform exercise.

Conclusion

If you have a thyroid condition, exercise can significantly improve your overall health and quality of life.

See your doctor before starting an exercise routine to ensure exercise is safe and appropriate.

Seek the guidance of a university-qualified exercise physiologist and dietitian for specific guidelines on exercise and diet tailored to your unique medical history.

Be safe and have fun!

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