Exercise guide
An underactive thyroid (hypothyroidism) means your thyroid gland doesn't make enough hormone. It's treated with a daily tablet, levothyroxine, usually for life, and with the right dose most people live a normal life. Exercise isn't a treatment for the thyroid and can't replace the tablet, but it can help you feel and work better: in small trials, a few months of aerobic or strength training improved fitness and quality of life.
The trials are small and mostly in women, many with mild (subclinical) hypothyroidism, so each piece of evidence below is graded to show how firm it is.
This guide covers exercising while your dose is being found and once you're stable, why you may feel tired and achy for a while, what the thyroid has to do with weight, how to take your tablet around training and supplements, and the warning signs that need help. It ends with moves you can follow in 3D, and workouts and plans.
An underactive thyroid is treated with levothyroxine, which replaces the hormone your thyroid can't make, usually for life; with the right dose you should be able to live a normal life. Two reviews of small trials disagree about whether exercise changes thyroid blood tests, and no guideline uses exercise to treat thyroid levels. Never change your dose to suit your training: talk to your GP.
In small trials, mostly in women, 12 to 16 weeks of aerobic, strength or combined training improved fitness and quality of life. The British Thyroid Foundation (BTF) says exercise "can improve both your energy levels and mood" and doesn't need to be vigorous. The usual guideline applies: 150 minutes of moderate activity a week, and strength work on 2 days.
Symptoms can take weeks to months to catch up with a change of dose, and the BTF says it can take several months to feel better. Until then exercise feels harder, because thyroid hormone sets the pace of the heart, circulation and muscles. Keep walking and doing light strength work, and save hard new training for when you feel well on a stable dose (our suggestion).
Tiredness, and muscle weakness, cramps and aches, are among the main symptoms. Two-thirds of 1,724 Dutch women on treatment said their thyroid condition limited their activity, and some people still find exercise harder despite normal blood tests. The National Institute for Health and Care Excellence (NICE) says day-to-day changes in symptoms are unlikely to be the thyroid, so plan by how you feel.
Most of the weight gained with an underactive thyroid is salt and water, often 5 to 10 pounds (about 2 to 4.5 kg), and treatment usually brings a small loss. Once your levels are normal, you can gain or lose weight like anyone else. A big change in weight can mean your dose needs checking.
Take it with water on an empty stomach, 30 to 60 minutes before breakfast, caffeine (pre-workout drinks included) or other medicines. Keep calcium, iron and multivitamins at least 4 hours away, and tell whoever takes your blood test if you take biotin, which can upset the results.
An underactive thyroid (hypothyroidism) "is a common condition where the thyroid gland in your neck does not make enough hormones", causing symptoms such as tiredness and weight gain. In subclinical (mild) hypothyroidism, a blood test shows a raised thyroid stimulating hormone (TSH) while thyroid hormone itself is still normal. It's often found by chance, though some people have symptoms.
The NHS lists feeling very tired, feeling cold, weight gain, constipation, difficulty concentrating, low mood, dry skin and hair or hair loss, a croaky voice, and irregular or heavy periods. They usually come on slowly. The BTF's longer list adds muscle weakness, cramps and aches, pins and needles in the hands (carpal tunnel syndrome), a slow heartbeat, slightly raised blood pressure and raised cholesterol. Our guides to leg cramps, carpal tunnel syndrome and frozen shoulder cover some of these.
About 2% of people in the UK have hypothyroidism, rising to more than 5% of those over 60, and women are 5 to 10 times more likely to have it than men. Subclinical hypothyroidism affects 4% to 20%, depending on who is studied. The commonest cause in the UK is Hashimoto's disease, where the immune system attacks the thyroid; it's most common in women and usually starts between 30 and 50. Other causes include thyroid surgery, radiotherapy to the neck, treatment for an overactive thyroid, and some medicines such as lithium and amiodarone.
NICE recommends a thyroid test for people with type 1 diabetes or another autoimmune condition, or with atrial fibrillation (a type of irregular heartbeat) that has just started, and suggests considering one with depression or unexplained anxiety.
A GP checks your TSH and thyroxine with a blood test. Treatment is levothyroxine, a synthetic version of your own thyroid hormone, usually for life. NICE suggests starting at 1.6 micrograms per kilogram of body weight a day for adults under 65 without heart disease, and at 25 to 50 micrograms a day, increased gradually, for people 65 and over or with heart disease. TSH is checked about every 3 months until it's stable, then once a year.
For subclinical hypothyroidism, NICE suggests considering levothyroxine if TSH is 10 or more on two tests 3 months apart, or a 6-month trial for adults under 65 with symptoms and a smaller rise.
Thyroid hormone sets the pace of the heart, circulation and muscles. With an underactive thyroid, poor support from the heart and circulation seems to be the main reason exercise feels hard: less blood reaches working muscles, which lean more on their own stores of sugar. Heart function can look normal at rest while the response to effort is impaired. In 23 people with subclinical hypothyroidism, peak power and fitness (VO2max, the most oxygen the body can use) were lower than in matched healthy people, with higher heart rates at the same effort.
A review of 38 studies (1,379 patients) found that exercise intolerance "is not always reversible" with adequate hormone treatment, leaving a significant group of treated people with lasting complaints. In a double-blind trial in 23 people with subclinical hypothyroidism, 6 months of levothyroxine eased muscle symptoms but didn't change how the muscles used energy during exercise. In another small trial of 23 people, moderate exercise became more efficient after 6 months of treatment.
Women are 5 to 10 times more likely to have hypothyroidism, and almost every exercise study is in women. There's no evidence that men need different advice; the studies didn't include them. Women with autoimmune thyroiditis reported more limits on activity than women whose hypothyroidism had other causes.
Levothyroxine is the treatment, usually for life. NICE offers it first and doesn't routinely offer liothyronine or natural thyroid extract, and neither NICE nor the NHS lists exercise as a treatment for thyroid levels. Never change your dose yourself: talk to your GP or pharmacist.
Two reviews disagree. One pooled 10 studies, of low to moderate quality and mostly in women with subclinical hypothyroidism, and found no significant change in TSH (data from 120 to 180 people) or in thyroid hormones. The other pooled 7 small randomised trials, mostly 12 weeks long, and reported a large fall in TSH, which it rated moderate certainty, and a rise in thyroxine, rated very low certainty. In a separate 12-week programme in 20 women, thyroid hormones didn't change.
Either way, exercise isn't a treatment for an underactive thyroid: levothyroxine is, and you should never change your dose without your GP.
In 60 women aged 35 to 45 on levothyroxine, 12 weeks of aerobic, strength or combined training at low to moderate intensity, 3 days a week, improved fitness, blood fats and quality of life compared with no training; combined training helped mental wellbeing most and aerobic training fitness most. In 20 women with subclinical hypothyroidism, 16 weeks of cycling and treadmill sessions (60 minutes, 3 times a week) improved quality of life, and in 18 women, 12 weeks of endurance training helped the heart respond faster to exercise. Two studies without a non-exercising comparison group found fitness gains of 28% and 37%.
The trials are small, and the largest was registered only after it had started.
In 1,724 Dutch women on thyroid hormone, fewer met the activity guideline than 1,802 women without thyroid disease, though more played sport. Two-thirds said their thyroid condition limited their activity, and only 16.1% met the Dutch recommendations. Women newly diagnosed with subclinical hypothyroidism took fewer steps and were weaker than healthy women (32 against 28).
Untreated hypothyroidism lowers exercise tolerance, mainly through the heart and circulation. Treatment improves it, but not always fully: some people on a stable dose still find exercise harder than before. These findings come from small physiology studies and reviews.
Two reviews (8 studies with 421 people, and 11 studies with 516 people) report better thyroid tests, cholesterol, mood and quality of life with yoga, but the studies were small, varied and mostly at moderate or high risk of bias, so they couldn't be pooled. In a 6-month online yoga trial in 134 people on levothyroxine, quality of life improved more than in people on a waiting list. The programmes mixed many poses with breathing and meditation, so none shows what a single pose does to the thyroid.
In a survey of 1,222 female runners aged 35 and over, mileage, pace and years of running weren't linked with a self-reported diagnosis of hypothyroidism, though women who started running at 10 or younger reported it more often, a finding the authors say needs checking. In US survey data, more vigorous activity went with lower odds of subclinical hypothyroidism, but a snapshot study can't show cause and effect.
Case reports describe severe untreated hypothyroidism causing muscle breakdown (rhabdomyolysis): after exertion, without an obvious trigger, and alongside a statin. All settled with thyroid hormone treatment. It's rare, and it's one reason to leave hard new training until treatment is working (our suggestion).
Keep up everyday activity and walking at a pace where you can talk easily; short bouts count. Light strength work twice a week, using a chair, a wall or a band, is reasonable. Leave out hard new training: high-intensity intervals, heavy lifting, long races or a big jump in how much you do. Expect some breathlessness and heaviness at first, and stop and get advice for chest pain, unusual breathlessness or a racing heartbeat.
Build up as you feel better rather than by the calendar. The BTF says it can take several months before you feel better and your tests settle, and NICE says TSH can take up to 6 months to settle after a very high level. A practical rule (our suggestion): add about 5 minutes to a session, or one set, each week while you feel well.
With a stable dose and normal tests, you can train like anyone else: the guideline amounts, and hard intervals or heavy lifting if you enjoy them (our editorial reading). One small trial trained women with subclinical hypothyroidism at 70% to 85% of their predicted maximum heart rate, and a review of 10 studies said exercise "seemed to be safe". No trial has tested very hard training.
People over 65 or with heart disease usually start on a lower dose that's built up slowly, so build exercise up slowly too. NICE avoids doses that suppress TSH, and notes that the harms of suppressing it, such as atrial fibrillation, are greater over 65. Our guide to exercise with heart disease covers training with a heart condition.
You're not alone: some people keep symptoms despite normal tests. The BTF suggests asking your GP to check for low iron, vitamin B12 or vitamin D, and coeliac disease, and NICE allows the dose to be adjusted for wellbeing as long as TSH isn't suppressed. The BTF says building rest into your day helps with fatigue, and shorter sessions with rest days in between may suit you better (our suggestion).
Tiredness, and muscle weakness, cramps and aches, are core symptoms, and the BTF says fatigue "should gradually begin to disappear" on levothyroxine. Because the body holds a large store of thyroxine, NICE says day-to-day changes in symptoms are unlikely to be the thyroid: plan easier days after poor sleep or illness (our suggestion).
Cramps and pins and needles in the hands (carpal tunnel syndrome) are listed symptoms. Our guides to leg cramps, carpal tunnel syndrome and frozen shoulder have stretches and exercises for each.
Source 11
Muscle pain or swelling, weakness, tiredness, fever and dark red to brown urine can be signs of muscle breakdown (rhabdomyolysis), which can start hours or days after exertion: seek medical attention urgently. It's rare, and in hypothyroidism it has been described in people whose thyroid wasn't yet treated.
The extra weight in hypothyroidism is mostly salt and water, often 5 to 10 pounds (about 2 to 4.5 kg), and treatment usually brings only a small loss, less than 10% of body weight. Once your thyroid levels are normal, "the ability to gain or lose weight is the same as in individuals who do not have thyroid problems". If weight gain is your only symptom, it's less likely to be due to the thyroid.
Source 16
Pushing the dose to lose weight "is unlikely to significantly change weight and may result in other metabolic problems", including loss of muscle, and too much levothyroxine causes side effects.
Once your levels are normal, weight loss works as it does for anyone else. Our weight-loss guide explains what exercise can and can't do for weight, and why strength training is worth keeping up.
Source 16
The dose depends on your weight, so the BTF advises a blood test after any significant change in weight; on weight loss injections, it suggests a thyroid test about 2 to 3 months after substantial weight loss. The NHS lists semaglutide among the medicines that may not mix well with levothyroxine, so tell your GP or pharmacist if you start it.
The NHS says to take it "on an empty stomach 30 to 60 minutes before your first meal of the day, any drink with caffeine, such as tea or coffee, or any other medicine", with water, at the same time each day. Pre-workout drinks and caffeine gels count as caffeine (our reading). The advice is about food, drink and medicines: none of it is about when you exercise.
Source 2
Take levothyroxine at least 4 hours apart from calcium, iron, some cholesterol-lowering medicines and multivitamins, and leave at least 4 hours between soya and your tablet. Some protein shakes contain soya or added calcium, so check the label (our suggestion). Kelp and sea moss sold as "thyroid boosters" are of no benefit with a diagnosed thyroid condition and may interfere with your thyroid. The NHS also lists St John's wort and some heart and blood pressure medicines among those that may not mix.
Biotin, found in some hair, skin and nail supplements, can make thyroid tests look wrong. The BTF passes on American advice to stop it 2 days before a blood test, and to tell whoever takes your blood about any supplements. Illness, thyroid and other medicines, and iodine or biotin supplements can all affect the results; exercise isn't on the BTF's list.
Take it consistently, and don't change your dose to suit training or weight goals: talk to your GP or pharmacist. If you've taken more than your prescribed dose, speak to a pharmacist as soon as possible, or call NHS 111.
Built on the NHS guidelines, the trial doses and the BTF's advice:
Build towards 150 minutes a week at a pace where you can talk but not sing. If you're tired, start with 10 minutes on most days and add about 5 minutes a week (our suggestion).
3D demoTreadmill walkingBeginner · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoRecumbent exercise bikeBeginner · Cardio machine
3D demoElliptical trainerBeginner · Cardio machine
3D demoIndoor Rowing (Rowing Machine)Beginner · Cardio machine
3D demoStanding marchBeginner · No equipment2 to 3 days a week, starting with 2 sets of 8 to 12 (our editorial starting point). Use the chair and wall versions while your dose is being found.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoWall push-upBeginner · A wall
3D demoIncline push-upBeginner · A bench or box
3D demoBand rowBeginner · A band + An anchor point
3D demoGlute bridgeBeginner · No equipment
3D demoLow step-upBeginner · A step
3D demoStep-upBeginner · A step
3D demoHip-hinge practiceBeginner · No equipment
3D demoDumbbell Romanian deadliftIntermediate · A dumbbell
3D demoFarmer's carryBeginner · A dumbbell + A kettlebellFor calf cramps, 3 holds of 20 to 30 seconds each side to a mild pull, as in our leg cramps guide. Slow breathing helps you wind down on tired days.
Next to a counter, 3 holds of 20 to 30 seconds on each leg, on at least 2 days a week.
While your dose is being found, start with the 10-minute starter workout or the easy cardio workout, and move on to the strength workouts as you feel better.
A 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 25-minute walk with short faster bouts: notice your heart and breathing speed up, then settle. A gentle way to get used to the feelings of effort.
25 minBeginner5 movesCardio machine, A wallA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 20-minute full-body dumbbell workout: two supersets of squats, rows, Romanian deadlifts and push-ups. Twice a week covers the minimum dose.
20 minBeginner8 movesA dumbbell, A bench or boxA 35-minute full-body strength workout with dumbbells: goblet squats, presses, rows, Romanian deadlifts and carries.
35 minIntermediate9 movesA band, A dumbbellA 25-minute gentle yoga class for complete beginners and over-50s: slow breathing, a warm-up, supported standing poses, floor poses and a closing rest.
25 minBeginner14 movesNo equipmentA free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesA bench or box, Something with weightA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightIf you're still finding your dose, repeat the first week's sessions until you feel better (our suggestion).
Your first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginner5 days a weekA 12-week workout plan for weight loss: three strength days, two cardio days and daily steps, building to 200 minutes a week, with honest results.
3 training days45 minBeginner3 days a weekA weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginnerUntreated hypothyroidism, or the wrong dose, raises the risk of heart disease, heart failure and osteoporosis, and the BTF reports a slightly lower life expectancy with long-term over- or under-treatment. Too much levothyroxine can cause a fast or irregular heartbeat. If your heart races or flutters during or after exercise, stop and get it checked (our suggestion).
An underactive thyroid raises cholesterol and heart risk, and NICE asks for a thyroid test before starting a statin in people with symptoms of thyroid disease. Our high cholesterol guide covers exercise for blood fats.
NICE warns that in menopausal women, symptoms of thyroid problems may be mistaken for the menopause. The BTF says the dose may need lowering around the menopause, and raising after starting combined hormone replacement therapy (HRT) as tablets. Our menopause guide covers strength, bone and heart.
Tell your GP if you're pregnant or planning a pregnancy: the dose usually needs to go up as soon as you know you're pregnant. Our pregnancy guide lists thyroid disease that isn't controlled among the conditions that rule out strenuous exercise in pregnancy.
More than 5% of people over 60 have hypothyroidism. From 65, the NHS advises strength, balance and flexibility work on at least 2 days a week.
Stop exercising and call 999 for:
Source 37
If someone suddenly becomes confused. Very rarely, a severe underactive thyroid leads to myxoedema coma, a life-threatening emergency that is more common in older people and needs hospital treatment.
If you take levothyroxine and think you're having a serious side effect, such as:
Source 2
As soon as possible if you've taken more than your prescribed dose of levothyroxine. If you can't, call NHS 111.
Source 2
For muscle pain or swelling, weakness and dark red to brown urine, especially after hard or unfamiliar exercise: it could be muscle breakdown (rhabdomyolysis).
Source 39
Speak to a GP first if you haven't exercised for some time, or if you have a medical condition such as heart disease.
Source 10
Levothyroxine replaces hormone your thyroid can't make, usually for life. Reviews of small exercise trials disagree on whether exercise changes TSH at all, and no guideline uses exercise to treat thyroid levels. Never reduce or stop your tablets without your GP.
Thyroid-related weight gain is modest and mostly salt and water. Once your levels are normal, you can gain or lose weight like anyone else.
Source 16
Pushing the dose is unlikely to change your weight much and can cause other problems, including muscle loss, and too much levothyroxine causes side effects. Kelp and sea moss boosters are of no benefit with a diagnosed thyroid condition.
Yoga studies tested whole programmes that mixed many poses with breathing and meditation, mostly small and at risk of bias, so none shows what one pose does to the thyroid. Yoga is a fine way to move and relax; shoulder stand has neck and eye cautions of its own.
In 1,222 female runners, mileage, pace and years of running weren't linked with hypothyroidism. The commonest cause in the UK is Hashimoto's disease, an autoimmune condition. Missed periods and exhaustion with heavy training are a different problem, covered in our menstrual cycle guide.
Symptoms can take weeks to months to catch up with treatment, and gentle, regular activity is fine in the meantime: the BTF recommends exercise for energy and mood. What's worth waiting for is a hard new programme (our suggestion).
No. Levothyroxine replaces the hormone your thyroid can't make, and most people take it for life. Small trials disagree about whether exercise changes thyroid blood tests at all, and no guideline uses it as a treatment. Exercise helps you feel and function better while the tablet does its job.
Yes. In small trials, 12 to 16 weeks of aerobic, strength or combined training improved fitness and quality of life in people with an underactive thyroid, and the British Thyroid Foundation says exercise can improve energy and mood. It doesn't need to be vigorous.
A mix you'll keep doing: brisk walking, cycling or swimming on most days, and strength work on 2 days a week. In one trial, aerobic, strength and combined training all helped, with combined training best for mental wellbeing and aerobic training best for fitness. If your joints ache, start with low-impact options such as cycling.
You don't need to stop moving: walking and light strength work are fine while your dose is being found. Symptoms can take weeks to months to catch up with treatment, so build up as you feel better. Save hard intervals or a big new programme until you feel well on a stable dose.
It can take several months to feel better, and some people keep symptoms even with normal tests. Ask your GP about other causes, such as low iron, vitamin B12 or vitamin D, or coeliac disease; NICE allows the dose to be adjusted for wellbeing within safe limits. Short, regular sessions with rest days often suit tired spells.
It helps as it does for anyone, and our weight-loss guide explains what it can and can't do. The thyroid itself usually accounts for only a few kilos, mostly water, and once you're treated you can lose weight like anyone else. If your weight changes a lot, ask for a blood test, because the dose depends on your weight.
Take it with water on an empty stomach, 30 to 60 minutes before breakfast, coffee or tea (pre-workout drinks included) or other medicines. Keep calcium, iron and multivitamin supplements at least 4 hours away. The official advice is about food, drink and medicines, not about when you exercise.
Exercise isn't on the British Thyroid Foundation's list of things that affect thyroid tests; illness, thyroid and other medicines, and supplements containing iodine or biotin are. Biotin, found in some hair, skin and nail supplements, can give false results, so tell the person taking your blood. The foundation passes on advice to stop it 2 days before a test.
Check with a pharmacist first. Caffeine needs to wait until 30 to 60 minutes after your tablet, biotin can upset blood tests, and soya, calcium and iron reduce how much levothyroxine you absorb if taken too close to it. Thyroid boosters such as kelp are of no benefit with a diagnosed thyroid condition.
Yoga is a good way to move and relax, and small trials suggest it may help quality of life. But the studies are small, mostly at risk of bias, and tested whole programmes, so none shows that any single pose stimulates the thyroid. Shoulder stand has neck and eye cautions of its own.
There's no good evidence that it does: in 1,222 women runners, training volume and pace weren't linked with hypothyroidism. The commonest cause in the UK is Hashimoto's disease, an autoimmune condition. If heavy training comes with missed periods and exhaustion, see a GP: that's a different problem.
Yes, with a gentler start: people over 65 or with heart disease usually start on a lower dose that's built up slowly, so build exercise up slowly too. Stop and get help for chest pain or unusual breathlessness, and tell your GP about palpitations, which can mean the dose is too high. Balance and strength work help prevent falls.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
