Exercise For Thyroid Disorders

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The thyroid and parathyroid glands are anatomically situated in the front part of the neck, but have different functions.

The thyroid is a butterfly-shaped gland near the voice box, which helps regulate the body’s metabolism.

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The parathyroid is attached to the back of the thyroid gland and produces parathyroid hormone that helps regulate calcium, phosphorus, and vitamin D levels in the bone and blood (Vanders Human Physiology, 2008).

Thyroid and parathyroid glands

Abnormalities in either of these glands can result in a cascade of metabolic issues, which can negatively affect health status.

Conditions affecting the thyroid gland include:

  • Hypothyroidism (low thyroid hormone): may result in weight gain, fatigue, and depression.
  • Hyperthyroidism (high levels of thyroid hormone): may cause weight loss, nervousness, and a rapid heart rate.
  • Hyperparathyroidism results in the secretion of high levels of parathyroid hormone which may cause high calcium levels and other non-specific symptoms such as weakness, fatigue, depression, or aches and pains (National Endocrine and Metabolic Diseases Information Service).

 

Rationale for Exercise with Thyroid and Parathyroid Disease

There is very limited scientific research surrounding the impact of exercise training on thyroid function 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 surrounding 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 Prescription for Thyroid and Hyperthyroid Disease

More research is required to determine the effects of exercise on individuals with thyroid and parathyroid dysfunction. As a general rule, you should first ensure that your condition is well-managed and under the care of a qualified medical practitioner (i.e. endocrinologist) before participating in exercise.

Thyroid disorder exercise guidelines 

Aerobic Exercise

  • Frequency: ≥ 5 days per week to maximise energy expenditure (if obese) and/or improve cardiorespiratory fitness where weight control is not a primary concern.
  • Intensity:  40 to 75% heart rate reserve. Progress to higher intensities as tolerated, notwithstanding any precaution advised by your doctor.
  • Time (Duration): 30 to 60 minutes per day. If you are unable to tolerate long, continuous activities, consider intermittent bouts of 10 minutes duration accumulated throughout the day.
  • Type:  Select aerobic exercises, which engage the large musculature of the body. Perform resistance-training and progress as tolerated (ACSM)

 

Resistance Training and Thyroid Disease

The guidelines for resistance training in people with diagnosed and medically-managed thyroid and parathyroid dysfunction may be similar to those of the apparently healthy population. However, you should be prepared to adjust exercises as necessary to address specific other health problems and/or physical limitations:

  • Frequency:  Resistance training for each major muscle group 2 to 3 days per week with at least 48 hours separating the training sessions for the same muscle group.
  • Intensity (sets and repetitions): Train each muscle group for a total of 2 to 4 sets with a range of 8 to 12 repetitions per set with a rest interval of 2 to 3 minutes.
  • Duration: Session duration will vary depending on the number of exercises performed.
  • Type:  Adults are recommended to perform multi-joint exercises affecting more than one muscle group and targeting opposing (agonist/antagonist) muscle groups.  Single joint (isolation) movements may also be performed, but remember to consider the planes of movement and try to incorporate functional exercises with relevance to your activities of daily living.

Special Considerations

Exercise may play a therapeutic role in the treatment of thyroid and parathyroid disease, though medication and/or surgical intervention may be the preferred first line of treatment in hypo/hyperthyroidism and hyperparathyroidism, respectively.

Conditions that affect 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. Exercise 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.

About Author

Dr Bill Sukala is a Sydney-based clinical exercise physiologist, health writer, speaker, and media health expert. He has published health articles in major publications around the world and has given invited lectures across five continents. Click here for more information or follow Bill on Facebook, Instagram, Twitter, and

6 Comments

  1. Excellent review Bill!! Here in the US, I’ve noticed several weight loss products that contain iodine. Guessing the idea is that iodine is needed to make thyroid hormone. So replace iodine and thyroid hormone goes up?

    Not sure about Australia, but I would point out that here in the US, hypothyroidism is not caused by iodine deficiency but an autoimmune disorder.

    Theoretically additional iodine might cause temporary hyper-thyroidism as it might add to the effects of synthroid.

    Again, great review!
    Joe

  2. Ricky burgess on

    Hi bill I’m a personal trainer and my new client has hypothyroidism what exercises can I have her do and not do? I usually do free weights machines and cables as well as Cardio machines

    • Hi Ricky,
      Without knowing anything about your client, I would suggest to first find out what she likes/dislikes and what she is physically capable of doing. Bear in mind the effects of any medications she’s taking and their influence on exercise. Are there any meds that might influence her heart rate and blood pressure? As I said in my article, there isn’t much out there on thyroid disorders and exercise (official guidelines) so you’ll need to see if there are any physical limitations or reasons for which exercise might be contraindicated. If you can speak with her doc or her doc’s practice nurse, you might be able to glean some extra information that way.
      It sounds like you’ve got the tried and true basics knocked out with having weights, cables, and cardio equipment. Start her off easy and gradually progress her. Also remember to see how she feels the following morning. If she’s completely exhausted and can barely get out of bed, then you may need to adjust the workload accordingly. Hope this helps. Cheers, Bill

  3. Hi, Bill. Thank you for information above. I am a female, age 46. Have been trying my hardest to loose weight but nothing happens, I exercise, change eating habits and might loose 5 lbs and gain them back. A few years had half of my thyroid remove, I am not taking any medication because non was given, in recent weeks I notice my weight going up despite eating less and exercise. YOu have any suggestion on what direction to take. Please help and thank you very much for your imput.

    • Hi Lorena,
      Thanks for taking the time to leave a comment. Whilst I cannot legally provide any specific medical advice here, I would strongly recommend speaking to your specialist (ideally an endocrinologist) and perhaps get a referral to a registered clinical dietitian that has experience with your particular condition. I also admit I am not a fan of medications and am not a “shill for big pharma” as many idiots have suggested, but if you’ve had surgery to have your thyroid removed, then your doc might wish to run more blood work on you and evaluate that as a potential course of action. Weight control is governed by so many factors but hormones definitely play a role. And if they’re out of wack, then it would be wise to take steps to correct these imbalances and get them back on track. I hope this helps. Warm regards, Bill

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