Pilates for thyroid problems: an underactive or overactive thyroid and Hashimoto's

Pilates can't fix your thyroid

An underactive thyroid is treated with levothyroxine, usually for life, and an overactive one with tablets, radioactive iodine or surgery. Never change your dose to suit your training: talk to your GP.

Sources 1, 2

No study has tested Pilates in any thyroid condition

Our searches found none. Small trials of aerobic and strength training improved fitness and quality of life with an underactive thyroid, and reviews disagree on whether exercise changes thyroid blood tests.

Sources 3, 4, 5, 6

Exercise can lift energy and mood, and it doesn't need to be hard

The BTF says exercise "can improve both your energy levels and mood" and "does not need to be vigorous". A steady mat or chair class fits that.

Source 7

Tiredness can outlast treatment

Two-thirds of 1,724 Dutch women treated for an underactive thyroid said it limited their activity, and a review found that poor exercise tolerance isn't always reversed by treatment. Plan by how you feel.

Sources 8, 9

With an overactive thyroid, keep it gentle until it's controlled

Your heart is already working hard, you overheat sooner and your muscles are weaker. Go by feel, not heart rate, and build up, including strength work, once your team says your levels are under control.

Sources 10, 11, 12

Mind your bones and your eyes

Bone thins while the thyroid is overactive, so use the osteoporosis versions of moves until it recovers. With thyroid eye disease, ask your eye team before moves that take your head below your heart (our suggestion: no study has tested this).

Sources 13, 14, 15

An underactive thyroid

The thyroid doesn't make enough hormones, causing tiredness, weight gain, feeling cold, low mood, dry skin and hair, and aches. In the UK, the main cause is Hashimoto's disease, where the immune system attacks the thyroid; the NHS says it is "most common in women, and usually starts between the ages of 30 and 50". Untreated, or on the wrong dose, it raises the risk of heart problems and osteoporosis. The BTF also lists muscle weakness, cramps and pins and needles in the hands (carpal tunnel syndrome).

Sources 1, 16

An overactive thyroid

The thyroid makes too much hormone. About 4 in 5 people with it have Graves' disease. Symptoms include nervousness, poor sleep, tiredness, muscle weakness, feeling too hot, palpitations, trembling and weight loss. Treatment is tablets, radioactive iodine or surgery, often with a beta blocker meanwhile. The NHS lists an overactive thyroid among the causes of atrial fibrillation (an irregular heartbeat) and of osteoporosis.

Sources 2, 17, 18, 19

Why exercise feels harder

With an underactive thyroid, the heart and circulation give the muscles less support during effort. With an overactive one, the heart rate can't rise enough with effort and the muscles use energy less efficiently. Heart function can look normal at rest while exercise shows the problem.

Sources 20, 10

What Pilates offers

Steady, low-impact strength and mobility work at your own pace, which suits the BTF's advice that exercise doesn't need to be vigorous. It doesn't change thyroid hormone levels.

Sources 7, 3

No study of Pilates

Our searches of PubMed, Europe PMC and ClinicalTrials.gov in November 2026 found no study of Pilates in an underactive or overactive thyroid, Hashimoto's or Graves' disease. Everything this page says about Pilates is our reading of the wider evidence.

Source 3

Exercise and thyroid blood tests: reviews disagreeMixed evidence

One review of 10 small studies found exercise made no significant difference to thyroid function; another, of 7 trials, reported a large fall in thyroid-stimulating hormone (TSH). Either way, levothyroxine is the treatment.

Sources 5, 6, 1

Fitness and quality of life: small trialsEmerging evidence

In 60 women 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. In 20 women with a mildly underactive thyroid, 16 weeks of aerobic training improved quality of life.

Sources 4, 21

Poor exercise tolerance can persistEmerging evidence

A review of 38 studies (1,379 people) found exercise intolerance with an underactive thyroid "is not always reversible during adequate hormone replacement therapy". In a survey of 1,724 women on thyroid hormone, two-thirds said their condition limited their activity, more often with Hashimoto's.

Sources 9, 22, 8

Yoga: small, open-label trialsMixed evidence

In 134 people on levothyroxine, 6 months of online yoga improved quality of life against a waiting list. Reviews of 11 and 13 yoga studies found mostly small trials at risk of bias. These were yoga programmes, not Pilates; our yoga for thyroid guide covers them.

Sources 23, 24, 25, 26

An overactive thyroid limits effort until it's treatedEmerging evidence

In 12 women with Graves' disease, the work rate reached in an exercise test was 50% while the thyroid was overactive, against 70% once levels were normal, mainly because the heart rate couldn't rise enough. Muscle weakness affected 62% at diagnosis and cleared on treatment in about 3.6 months on average. In 16 people, strength training twice a week alongside tablets roughly doubled the strength regained (not randomised). In a small study, some people's walking and breathing-muscle endurance still lagged once levels were normal.

Sources 10, 12, 27, 28

Build up as treatment works

Our editorial starting point: a steady mat or chair class 2 or 3 times a week alongside walking, building by how you feel rather than the calendar. The trials that helped used 3 sessions a week for 12 to 16 weeks. Pilates counts as strength work; the NHS also asks adults for 150 minutes of moderate activity a week.

Sources 7, 4, 29

On tired days

Do the seated or lying parts only, or rest (our suggestion). If you still feel unwell on treatment, the BTF says your doctor may look for other causes, such as low iron, low vitamin B12, low vitamin D or coeliac disease.

Sources 30, 9

Your tablet and morning classes

The NHS says to take levothyroxine on an empty stomach, 30 to 60 minutes before your first meal of the day, any drink with caffeine or any other medicine. An early class doesn't change that.

Source 31

Weight

The BTF says much of the weight gained with an underactive thyroid is salt and water, and once your levels are normal "the ability to gain or lose weight is the same" as for anyone. Pilates builds strength; walking or other cardio adds the aerobic part.

Sources 32, 29

Cramps and aching

Warm up well and stretch gently; our leg cramps guide has more. Muscle pain that's new, with weakness and dark urine, needs urgent help (warning signs below).

Source 16

No exercise trial yetMixed evidence

A 2025 review of 12 publications called the field "more unknowns than facts" and asked for trials. A 2026 study of people with Hashimoto's whose thyroid levels were normal linked more time in high-intensity exercise with lower thyroid antibodies, but a link like this can't show that exercise lowers them.

Sources 33, 34

One yoga trialMixed evidence

In 62 women with Hashimoto's in India, 3 months of online yoga added to levothyroxine improved thyroid tests, mood and sleepiness against levothyroxine alone, but everyone knew which group they were in.

Source 24

What this means for Pilates

Hashimoto's is the commonest cause of an underactive thyroid, so the same plan applies. Pilates is a reasonable way to stay active; claims that it calms the immune system or lowers antibodies haven't been tested (our reading).

Sources 1, 33

Before your levels are under control

The NHS says "Regular exercise and managing stress can help with other symptoms such as anxiety, irritability, difficulty sleeping and hyperactivity". Our suggestion, as our overactive thyroid guide advises: seated and lying Pilates at an easy pace, breathing steadily with no breath holds, in a cool room. Stop for palpitations or dizziness, and leave hard training until your team says your levels are under control.

Sources 35, 10

Go by feel, not heart rate

With an overactive thyroid, your heart rate is high at rest and rises less than usual with effort, and a beta blocker slows it further, so heart rate zones and watch targets mislead. Use the talk test instead: at a moderate effort you can talk but not sing.

Source 10

Heat

Feeling too hot is a symptom, so skip hot Pilates until it's controlled (our suggestion, as our overactive thyroid guide says), and drink enough.

Source 2

Rebuild muscle once treatment works

Weakness, mainly in the thighs and upper arms, usually clears within a few months of treatment, and strength training twice a week helped it come back faster in a small study. Pilates helps; adding progressive strength work rebuilds muscle faster (our suggestion).

Sources 12, 27

Atrial fibrillation

8.3% of 40,628 people had atrial fibrillation or flutter when their overactive thyroid was diagnosed, more often men and older people, and most return to a normal rhythm within 4 to 6 months of the thyroid being controlled. If you have it, follow your heart team's advice; our Pilates for heart health guide covers the changes.

Sources 11, 36

Weight after treatment

In 162 people, weight went up by about 4 kg on average in the year after treatment. That's common and not a sign you're doing anything wrong; regular strength work and activity help you feel stronger as it settles (our suggestion).

Source 37

Bone thins while the thyroid is overactive

Across 20 studies, bone density was low in an untreated overactive thyroid and returned to normal with treatment. A very low TSH, from the thyroid or from too much levothyroxine, was linked with hip and spine fractures, which is one reason the National Institute for Health and Care Excellence (NICE) advises against levothyroxine doses that suppress TSH.

Sources 13, 14, 38, 19

Pilates swaps for thin bones

Until your bones have recovered, or if you've been told they're thin, use head-down versions of curl-ups and leave out rolling like a ball, the roll-over and deep forward rounding, as the UK osteoporosis consensus and the move pages advise. Our Pilates for osteoporosis guide has the full set of swaps.

Source 39

Thyroid eye disease and head-down moves

Thyroid eye disease affects around 1 in 4 people with an overactive thyroid caused by Graves' disease, with dry, gritty or red eyes, double vision or bulging eyes. Our suggestion: ask your eye team before the roll-over, jack knife, control balance and legs up the wall, which take your head below your heart. No study has tested this; we've extrapolated from the glaucoma cautions on those moves and our yoga for thyroid guide.

Sources 40, 15

After thyroid surgery

Walk from the first days, and start gentle neck movements and floor work when your surgical team says you can; leave head-down moves until much later (our suggestion, agreeing with our overactive thyroid and yoga for thyroid guides). Our overactive thyroid guide covers neck exercise after surgery.

Tell the medical staff straight away about tingling in your hands, fingers or around your mouth.

Source 2

Head-down and weight-on-the-neck moves

The roll-over, jack knife, control balance and boomerang: leave them out after thyroid surgery until your team agrees, and with thyroid eye disease ask your eye team first (our suggestion, extrapolated from the moves' glaucoma cautions; no study has tested it).

Source 15

Hot Pilates

Leave it out until an overactive thyroid is controlled (our suggestion, as our overactive thyroid guide says for hot yoga and saunas).

Source 2

Hard, fast or breath-holding work

A fast hundred, the teaser series and jumping on a reformer's jumpboard: leave them until your levels are under control and you feel well, and keep any breath-led moves slow (our suggestion).

Sources 10, 11

With thin bones

Use the osteoporosis swaps: head-down curl-ups, and no rolling like a ball, roll-over or deep forward rounding.

Sources 39, 13, 14

On a beta blocker

Get up slowly from the mat, as the warning signs below set out.

Source 41

Call 999

Stop exercising and call 999 for:

• Chest pain that feels tight or like squeezing, or spreads to your arms, neck or jaw.
• Severe difficulty breathing: gasping, choking or not able to get words out.
• Lips or skin that are pale, blue or grey.
• Someone who has passed out and isn't responding normally.

Sources 42, 43

A racing or irregular heartbeat

Call 999 or go to A&E if you have palpitations that don't go away, or that come with chest pain, shortness of breath, or feeling faint or fainting. If they've stopped, ask your GP surgery for an urgent appointment or call 111. Call 999 if someone faints while exercising.

Sources 44, 41

Thyroid storm: call 999

The NHS says a thyroid storm is a medical emergency: call 999 for an ambulance straight away if you think you or someone in your care has one. The signs are:

• A rapid heartbeat.
• A high temperature.
• High blood pressure.
• Yellowing of the skin and eyes (jaundice).
• Severe agitation and confusion.
• Loss of consciousness.

Source 40

Go to A&E or call 999

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.

Source 1

Call NHS 111

If you take levothyroxine and think you're having a serious side effect, such as:

• A high temperature, a fast or irregular heartbeat, or feeling dizzy or faint, which can be signs of a thyroid crisis.
• Yellowing of the eyes or skin.

Source 31

On carbimazole or propylthiouracil

If you take carbimazole or propylthiouracil, contact your doctor immediately if you get a high temperature, sore throat or persistent cough: rarely, these tablets cause a sudden drop in the white blood cells that fight infection. The BTF has an alert card to carry. The NHS says to call your doctor or 111 straight away on carbimazole if your skin or the whites of your eyes turn yellow, you have dark pee, or you get muscle pain or weakness.

Source 35

Your eyes

The BTF says to see your GP or eye specialist urgently if your eye symptoms get worse over days or weeks, blurred vision doesn't clear when you blink, colours look less bright, you see double when looking straight ahead or down, or you tilt your head to avoid seeing double.

Source 15

Get medical help urgently

For muscle pain or swelling, weakness and dark red to brown urine, especially after hard or unfamiliar exercise: it could be muscle breakdown (rhabdomyolysis).

See a GP

• You think you might have an underactive thyroid.
• You take levothyroxine and are pregnant or planning a pregnancy.
• Side effects bother you or don't go away (or speak to a pharmacist).
• You still feel unwell after several months on treatment with normal tests.
• A lump in your neck that grows quickly, a hoarse voice, difficulty swallowing or shortness of breath.
• An irregular or fast heart rate, or palpitations during or after exercise.
• You have symptoms of an overactive thyroid.
• Palpitations keep coming back, last more than a few minutes, or you have a heart condition or a family history of heart problems.
• You have fainted.
• After radioactive iodine or surgery, you feel tired, cold, low or gain weight, which can mean an underactive thyroid.

Sources 1, 2, 44

Stop and rest

Stop exercising if your heart races or flutters, you feel dizzy or unusually breathless, or you feel too hot, then cool down and drink (our suggestion).

Chest pain or fainting: call 999

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 43, 41, 42

Getting up on a beta blocker

• Finish all your lying moves before you sit up, so you change position as few times as you can.
• Roll onto your side, then push yourself up to sitting with your arms.
• Sit for a minute or so before you kneel or stand.
• Stand up slowly, with a chair or counter within reach.
• Pause before you walk off. If you feel light-headed, cross your legs or clench your buttocks and tummy muscles.
• If you still feel faint, lie down with your legs raised.

Source 41

Breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 45

Stop the session if

You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.

Source 46

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

Source 46

"Pilates fixes an underactive thyroid"Strong evidence

Levothyroxine is the treatment, usually for life. Reviews disagree on whether exercise changes TSH at all, and no Pilates study exists.

Sources 1, 5, 6, 3

"Certain Pilates or yoga moves stimulate the thyroid"Mixed evidence

No study has tested any single move on the thyroid; the yoga trials tested whole programmes. Our yoga for thyroid guide calls the shoulder stand claim a myth.

Source 26

"Pilates lowers thyroid antibodies in Hashimoto's"Mixed evidence

No trial has tested it. One study linked more high-intensity exercise with lower antibodies, which can't show cause.

Sources 33, 34

"You can't lose weight with an underactive thyroid"Strong evidence

Once your levels are normal, the BTF says, the ability to gain or lose weight is the same as for anyone.

Source 32

"Hard exercise burns off an overactive thyroid"Emerging evidence

Untreated, the heart is already working hard and capacity is low. Gentle, regular activity helps symptoms; hard training waits for treatment.

Sources 10, 35

"Exercise can get you off antithyroid tablets"Mixed evidence

One weak, retrospective study claimed it, and it hasn't been repeated. Never stop or change a medicine yourself.

Source 47

"You must wait until your levels are normal before any Pilates"Emerging evidence

Gentle, regular activity is fine meanwhile, and the BTF recommends exercise for energy and mood. What waits is hard training.

Sources 7, 35