The impact of physical activity and diet in the treatment of hypothyroidism: A systematic review
DOI:
https://doi.org/10.12775/QS.2024.20.54107Keywords
hypothyroidism, diet, physical activity;Abstract
Introduction and Objective: Thyroid diseases constitute a significant health challenge of the 21st century. Due to the growing awareness of the accompanying symptoms and the impact of the proper functioning of the thyroid gland on the overall condition of the body, patients show increasing interest in therapeutic methods. The main aim of the article is to present the impact of physical activity and proper diet on the management of patients with hypothyroidism.
Review and Methods: Review and summary of studies and meta-analysis of studies available in open-source format on Google Scholar, Web of Science and PubMed.
Abbreviated Description of the State of Knowledge: Hypothyroidism is a clinical condition characterized by the insufficient production of thyroid hormones by the thyroid gland. This hormonal deficiency leads to a generalized decrease in metabolic processes. Clinically, hypothyroidism is diagnosed based on elevated serum levels of thyroid-stimulating hormone (TSH) and decreased levels of free thyroxine (T4). Prevalent symptoms include fatigue, constipation, weight gain, cold intolerance, depression and dry skin. Effective management typically involves hormone replacement therapy with synthetic thyroxine.
Summary: Hypothyroidism is a complex disease influenced by many factors. A multidisciplinary approach is recommended in its treatment, including pharmacological treatment, diet and appropriately selected physical activity. Early diagnosis and treatment are essential to improve the physical and mental condition of patients.
References
Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism. Nat Rev Dis Primers. 2022 May 19;8(1):30. doi: 10.1038/s41572-022-00357-7. Erratum in: Nat Rev Dis Primers. 2022 Jun 10;8(1):39.
doi: https://doi.org/10.1038/s41572-022-00357-7 PMID: 35589725.
Muraca E, Ciardullo S, Oltolini A, Zerbini F, Bianconi E, Perra S, Villa M, Cannistraci R, Castoldi G, Pizzi P, Manzoni G, Lattuada G, Perseghin G. Resting Energy Expenditure in Obese Women with Primary Hypothyroidism and Appropriate Levothyroxine Replacement Therapy. J Clin Endocrinol Metab. 2020 Apr 1;105(4):dgaa097.
doi: https://doi.org/10.1210/clinem/dgaa097 PMID: 32119074.
Babić Leko M, Gunjača I, Pleić N, Zemunik T. Environmental Factors Affecting Thyroid-Stimulating Hormone and Thyroid Hormone Levels. Int J Mol Sci. 2021 Jun 17;22(12):6521.
doi: https://doi.org/10.3390/ijms22126521 PMID: 34204586; PMCID: PMC8234807.
Qiu Y, Liu Q, Luo Y, Chen J, Zheng Q, Xie Y, Cao Y. Causal association between obesity and hypothyroidism: a two-sample bidirectional Mendelian randomization study. Front Endocrinol (Lausanne). 2024 Jan 8;14:1287463.
doi: https://doi.org/10.3389/fendo.2023.1287463. PMID: 38260160; PMCID: PMC10801094.
Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev. 2019 Jun 1;40(3):789-824.
doi: https://doi.org/10.1210/er.2018-00163. PMID: 30649221; PMCID: PMC6507635.
Song RH, Wang B, Yao QM, Li Q, Jia X, Zhang JA. The Impact of Obesity on Thyroid Autoimmunity and Dysfunction: A Systematic Review and Meta-Analysis. Front Immunol. 2019 Oct 1;10:2349.
doi:https://doi.org/10.3389/fimmu.2019.02349. PMID: 31681268; PMCID: PMC6797838.
Biondi B. Subclinical Hypothyroidism in Patients with Obesity and Metabolic Syndrome: A Narrative Review. Nutrients. 2023 Dec 27;16(1):87.
doi: https://doi.org/10.3390/nu16010087. PMID: 38201918; PMCID: PMC10780356.
Triolo TM, Armstrong TK, McFann K, Yu L, Rewers MJ, Klingensmith GJ, Eisenbarth GS, Barker JM. Additional autoimmune disease found in 33% of patients at type 1 diabetes onset. Diabetes Care. 2011 May;34(5):1211-3.
doi: https://doi.org/10.2337/dc10-1756. Epub 2011 Mar 23. PMID: 21430083; PMCID: PMC3114477.
Nederstigt C, Uitbeijerse BS, Janssen LGM, Corssmit EPM, de Koning EJP, Dekkers OM. Associated auto-immune disease in type 1 diabetes patients: a systematic review and meta-analysis. Eur J Endocrinol. 2019 Feb 1;180(2):135-144.
doi: https://doi.org/10.1530/EJE-18-0515. PMID: 30508413.
Skov J, Kuja-Halkola R, Magnusson PKE, Gudbjörnsdottir S, Kämpe O, Bensing S. Shared etiology of type 1 diabetes and Hashimoto's thyroiditis: a population-based twin study. Eur J Endocrinol. 2022 May 9;186(6):677-685.
doi: https://doi.org/10.1530/EJE-22-0025. PMID: 36321757; PMCID: PMC9175555.
Li L, Liu S, Yu J. Autoimmune thyroid disease and type 1 diabetes mellitus: same pathogenesis; new perspective? Ther Adv Endocrinol Metab. 2020 Sep 14;11:2042018820958329.
doi: https://doi.org/10.1177/2042018820958329. PMID: 32973994; PMCID: PMC7493255.
Boelaert K, Newby PR, Simmonds MJ, Holder RL, Carr-Smith JD, Heward JM, Manji N, Allahabadia A, Armitage M, Chatterjee KV, Lazarus JH, Pearce SH, Vaidya B, Gough SC, Franklyn JA. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. Am J Med. 2010 Feb;123(2):183.e1-9.
doi: https://doi.org/10.1016/j.amjmed.2009.06.030. PMID: 20103030.
Hemminki K, Li X, Sundquist J, Sundquist K. Familial association between type 1 diabetes and other autoimmune and related diseases. Diabetologia. 2009 Sep;52(9):1820-8.
doi: https://doi.org/10.1007/s00125-009-1427-3. Epub 2009 Jun 20. PMID: 19543881.
Anaya JM, Castiblanco J, Tobón GJ, García J, Abad V, Cuervo H, Velásquez A, Angel ID, Vega P, Arango A. Familial clustering of autoimmune diseases in patients with type 1 diabetes mellitus. J Autoimmun. 2006 May;26(3):208-14.
doi: https://doi.org/10.1016/j.jaut.2006.01.001. Epub 2006 Feb 24. PMID: 16503115.
Jonklaas J. Hypothyroidism, lipids, and lipidomics. Endocrine. 2024 May;84(2):293-300.
doi: https://doi.org/10.1007/s12020-023-03420-9. Epub 2023 Jun 17. PMID: 37329413; PMCID: PMC11076307.
Roa Dueñas OH, Koolhaas C, Voortman T, Franco OH, Ikram MA, Peeters RP, Chaker L. Thyroid Function and Physical Activity: A Population-Based Cohort Study. Thyroid. 2021 Jun;31(6):870-875.
doi: https://doi.org/10.1089/thy.2020.0517. Epub 2020 Dec 23. PMID: 33198599.
Tian L, Lu C, Teng W. Association between physical activity and thyroid function in American adults: a survey from the NHANES database. BMC Public Health. 2024 May 10;24(1):1277.
doi: https://doi.org/10.1186/s12889-024-18768-4. PMID: 38730302; PMCID: PMC11084014.
Ahn N, Kim HS, Kim K. Exercise training-induced changes in metabolic syndrome parameters, carotid wall thickness, and thyroid function in middle-aged women with subclinical hypothyroidism. Pflugers Arch. 2019 Mar;471(3):479-489.
doi: https://doi.org/10.1007/s00424-019-02254-7. Epub 2019 Jan 18. PMID: 30656407.
Duñabeitia I, González-Devesa D, Varela-Martínez S, Diz-Gómez JC, Ayán-Pérez C. Effect of physical exercise in people with hypothyroidism: systematic review and meta-analysis. Scand J Clin Lab Invest. 2023 Dec;83(8):523-532.
doi: https://doi.org/10.1080/00365513.2023.2286651. Epub 2024 Jan 24. PMID: 37999992.
Lankhaar JAC, Kemler E, Hofstetter H, Collard DCM, Zelissen PMJ, Stubbe JH, Backx FJG. Physical activity, sports participation and exercise-related constraints in adult women with primary hypothyroidism treated with thyroid hormone replacement therapy. J Sports Sci. 2021 Nov;39(21):2493-2502.
doi: https://doi.org/10.1080/02640414.2021.1940696. Epub 2021 Jun 24. PMID: 34165042.
Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J. 2017 Apr-Jun;13(2):55-59.
doi: https://doi.org/10.14797/mdcj-13-2-55. PMID: 28740582; PMCID: PMC5512679.
Sadek SH, Khalifa WA, Azoz AM. Pulmonary consequences of hypothyroidism. Ann Thorac Med. 2017 Jul-Sep;12(3):204-208.
doi: https://doi.org/10.4103/atm.ATM_364_16. PMID: 28808493; PMCID: PMC5541969.
Fariduddin MM, Haq N, Bansal N. Hypothyroid Myopathy. 2024 Jun 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30137798.
Lankhaar JAC, Kemler E, Stubbe JH, Backx FJG. Physical Activity in Women With Hypothyroidism on Thyroid Hormone Therapy: Associated Factors and Perceived Barriers and Benefits. J Phys Act Health. 2021 Oct 9;18(11):1383-1392.
doi: https://doi.org/10.1123/jpah.2021-0230. PMID: 34627125.
Dhuli K, Naureen Z, Medori MC, Fioretti F, Caruso P, Perrone MA, Nodari S, Manganotti P, Xhufi S, Bushati M, Bozo D, Connelly ST, Herbst KL, Bertelli M. Physical activity for health. J Prev Med Hyg 2022;63(suppl.3):E150-E159.
doi: https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2756.
Xiang GD, Pu J, Sun H, Zhao L, Yue L, Hou J. Regular aerobic exercise training improves endothelium-dependent arterial dilation in patients with subclinical hypothyroidism. Eur J Endocrinol. 2009 Nov;161(5):755-61.
doi: https://doi.org/10.1530/EJE-09-0395. Epub 2009 Sep 8. PMID: 19737872.
Mastrototaro, L., & Roden, M. (2021). Insulin resistance and insulin sensitizing agents. Metabolism: clinical and experimental, 125, 154892.
doi: https://doi.org/10.1016/j.metabol.2021.154892
Oppert JM, Bellicha A, van Baak MA, Battista F, Beaulieu K, Blundell JE, Carraça EV, Encantado J, Ermolao A, Pramono A, Farpour-Lambert N, Woodward E, Dicker D, Busetto L. Exercise training in the management of overweight and obesity in adults: Synthesis of the evidence and recommendations from the European Association for the Study of Obesity Physical Activity Working Group. Obes Rev. 2021 Jul;22 Suppl 4(Suppl 4):e13273.
doi: https://doi.org/10.1111/obr.13273. Epub 2021 Jun 2. PMID: 34076949; PMCID: PMC8365734.
Luo B, Xiang D, Ji X, Chen X, Li R, Zhang S, Meng Y, Nieman DC, Chen P. The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review. J Sport Health Sci. 2024 May;13(3):353-367.
doi: https://doi.org/10.1016/j.jshs.2024.02.002. Epub 2024 Feb 9. PMID: 38341137; PMCID: PMC11117003.
Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H, Shoenfeld Y. Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmun Rev. 2018 Jan;17(1):53-72.
doi: https://doi.org/10.1016/j.autrev.2017.11.010. Epub 2017 Nov 3. PMID: 29108826.
Elgayar SL, Elgendy S, Youssef TM. Comparative effects of aerobic, resistance, and combined exercises on depression and sleep quality in women with controlled hypothyroidism. A randomized controlled trial. Advances in Rehabilitation. 2024;38(1):9-19.
doi: https://doi.org/10.5114/areh.2024.136292.
E. Zakrzewska, M. Zegan., E. Michota-Katulska, D. Szostak-Węgierek. Zalecenia dietetyczna w niedoczynności tarczycy przy współwystępowaniu choroby Hashimoto. BromChemTokskol.2015;48(2):117–127.
Jarosz M, Stolińska H, Wolańska D. Żywienie w niedoczynności tarczycy. PZWL, Warszawa 2016: Warszawa.
Martins VJB, Filgueiras AR, Almeida VBP, de Moraes RCS, Sawaya AL. Changes in Thyroid and Glycemic Status and Food Intake in Children with Excess Weight Who Were Submitted for a Multi-Component School Intervention for 16 Months. International Journal of Environmental Research and Public Health. 2020; 17(11):3825.
doi: https://doi.org/10.3390/ijerph17113825.
Peeters, R. P. (2017). Subclinical hypothyroidism. New England Journal of Medicine, 376(26), 2556-2565.
DOI: https://doi.org/10.1056/NEJMcp1611144.
Reinehr T. Obesity and thyroid function. Mol Cell Endocrinol. 2010 Mar 25;316(2):165-71.
doi: https://doi.org/10.1016/j.mce.2009.06.005. Epub 2009 Jun 18. PMID: 19540303.
Redman LM, Ravussin E. Endocrine alterations in response to calorie restriction in humans. Mol Cell Endocrinol. 2009; 299(1): 129–136,
doi: https://doi.org/10.1016/j.mce.2008.10.014, indexed in Pubmed: 19007855.
Partsalaki I, Markantes GK, Michalaki MA. Low-Glycemic Load Diets and Thyroid Function: A Narrative Review and Future Perspectives. Nutrients. 2024; 16(3):347.
doi: https://doi.org/10.3390/nu16030347.
Vagenakis AG, Burger A, Portnary GI, Rudolph M, O'Brian JR, Azizi F, Arky RA, Nicod P, Ingbar SH, Braverman LE. Diversion of peripheral thyroxine metabolism from activating to inactivating pathways during complete fasting. J Clin Endocrinol Metab. 1975 Jul;41(1):191-4.
doi: https://doi.org/10.1210/jcem-41-1-191. PMID: 1150863.
Basolo A, Begaye B, Hollstein T, Vinales KL, Walter M, Santini F, Krakoff J, Piaggi P. Effects of Short-Term Fasting and Different Overfeeding Diets on Thyroid Hormones in Healthy Humans. Thyroid. 2019 Sep;29(9):1209-1219.
doi: https://doi.org/10.1089/thy.2019.0237. Epub 2019 Aug 9. PMID: 31298652; PMCID: PMC6864752.
Benvenga S, Famà F, Perdichizzi LG, Antonelli A, Brenta G, Vermiglio F, Moleti M. Fish and the Thyroid: A Janus Bifrons Relationship Caused by Pollutants and the Omega-3 Polyunsaturated Fatty Acids. Front Endocrinol (Lausanne). 2022 May 27;13:891233.
doi: https://doi.org/10.3389/fendo.2022.891233. PMID: 35712237; PMCID: PMC9196333.
Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol. 2015; 3(4): 286–295,
doi: https://doi.org/10.1016/S2213-8587(14)70225-6, indexed in Pubmed: 25591468.
Institute of Medicine (US) Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington (DC): National Academies Press (US); 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK222310/
doi: https://doi.org/10.17226/10026
Ventura M, Melo M, Carrilho F. Selenium and Thyroid Disease: From Pathophysiology to Tre- atment. Int J Endocrinol. 2017; 2017: 1297658,
doi: https://doi.org/10.1155/2017/1297658, indexed in Pubmed: 28255299.
Luo J, Hendryx M, Dinh P, et al. Association of Iod- ine and Iron with Thyroid Function. Biol Trace Elem Res. 2017; 179(1): 38–44,
doi: https://doi.org/10.1007/s12011-017-0954-x, indexed in Pubmed: 28160243.
Skelin M, Lucijanić T, Amidžić Klarić D, et al. Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review. Clin Ther. 2017; 39(2): 378–403,
doi: https://doi.org/10.1016/j.clinthera.2017.01.005, indexed in Pubmed: 28153426.
Skelin M, Lucijanić T, Liberati-Čizmek AM, Klobučar SM, Lucijanić M, Jakupović L, Bakula M, Lončar JV, Marušić S, Matić T, Romić Ž, Dumić J, Rahelić D. Effect of timing of levothyroxine administration on the treatment of hypothyroidism: a three-period crossover randomized study. Endocrine. 2018 Nov;62(2):432-439.
doi: https://doi.org/10.1007/s12020-018-1686-1 Epub 2018 Jul 24. PMID: 30043093.
Perez CL, Araki FS, Graf H, de Carvalho GA. Serum thyrotropin levels following levothyroxine administration at breakfast. Thyroid. 2013 Jul;23(7):779-84.
doi: https://doi.org/10.1089/thy.2012.0435 Epub 2013 Jun 21. PMID: 23363386.
Otun J, Sahebkar A, Östlundh L, Atkin SL, Sathyapalan T. Systematic Review and Meta-analysis on the Effect of Soy on Thyroid Function. Sci Rep. 2019 Mar 8;9(1):3964.
doi: https://doi.org/10.1038/s41598-019-40647-x PMID: 30850697; PMCID: PMC6408586.
Lilja JJ, Laitinen K, Neuvonen PJ. Effects of grapefruit juice on the absorption of levothyroxine. Br J Clin Pharmacol. 2005 Sep;60(3):337-41.
doi: doi.org/10.1111/j.1365-2125.2005.02433.x PMID: 16120075; PMCID: PMC1884777.
Chon DA, Reisman T, Weinreb JE, Hershman JM, Leung AM. Concurrent Milk Ingestion Decreases Absorption of Levothyroxine. Thyroid. 2018 Apr;28(4):454-457.
doi: https://doi.org/10.1089/thy.2017.0428 Epub 2018 Mar 28. PMID: 29589994; PMCID: PMC5905419.
Liu H, Lu M, Hu J, Fu G, Feng Q, Sun S, Chen C. Medications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review. Ther Clin Risk Manag. 2023 Jun 23;19:503-523.
doi: https://doi.org/10.2147/TCRM.S414460 PMID: 37384019; PMCID: PMC10295503.
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