The Impact of Intense Physical Exercise on the Hormonal Profile, Metabolic Functions and Immune Response in Patients with Hashimoto’s Disease – A Literature Review
DOI:
https://doi.org/10.12775/QS.2026.63.73347Keywords
physical exercise, physical exertion, hypothyroidism, Hashimoto’s disease, autoimmune thyroiditisAbstract
Background: Hashimoto's disease is the most common cause of hypothyroidism. While moderate exercise is recommended as a non-pharmacological component of treatment, the body's response depends strongly on the intensity and load of exercise.
Aim: To review the impact of intense physical exercise on the hormonal, metabolic, and immune profiles of patients with Hashimoto's disease
Material and methods: A review of clinical and population studies evaluating physiological and immune responses to various exercise intensities in Hashimoto’s disease
Results: Studies reveal a “physical activity paradox”. Moderate exercise lowers TSH and antibody levels. However, extreme exertion (e.g., heavy occupational work or >1,520 active mins/week) exacerbates autoimmunity. Exhaustive exercise increases the risk of overt hypothyroidism, raises TSH and anti-TPO antibodies, and decreases free hormones (fT4, fT3). It also induces a "low T3 syndrome" during recovery, triggers transient immune dysfunction, and worsens pathological exercise intolerance, which significantly increases the risk of life-threatening rhabdomyolysis.
Conclusions: Intensive, exhaustive training in uncontrolled Hashimoto's patients is highly contraindicated, causing endocrine breakdown and inflammation. Only precisely dosed, moderate aerobic exercise with absolute respect for prolonged recovery times is recommended.
References
1. Opstad PK, Falch D, Aktedalen F. (The thyroid function in young men during prolonged exercise and the effect of energy and sleep deprivation. Clin Endocrinol (Oxf) 1984;20:657–69. https://doi.org/10.1111/j.1365-2265.1984.tb00116.x.
2. Krotkiewski M, Sjöström L, Sullivan L, Lundberg P‐A, Lindstedt G, Wetterqvist H, et al. The effect of acute and chronic exercise on thyroid hormones in obesity. Acta Med Scand 1984;216:269–75. https://doi.org/10.1111/j.0954-6820.1984.tb03804.x.
3. Smallridge RC, Whorton NE, Burman KD, Ferguson EW. Effects of exercise and physical fitness on the pituitary-thyroid axis and on prolactin secretion in male runners. Metabolism 1985;34:949–54. https://doi.org/10.1016/0026-0495(85)90144-1.
4. Ashimoto T, Igita S, Matsubara F. Response of Thyrotropin, Prolactin and Free Thyroid Hormones to Graded Exercise in Normal male Subjects. Endocrinol Jpn 1986;33:735–41. https://doi.org/10.1507/endocrj1954.33.735.
5. Hohtari H, Pakarinen A, Kauppila A. Serum concentrations of thyrotropin, thyroxine, triiodothyronine and thyroxine binding globulin in female endurance runners and joggers. Acta Endocrinol (Copenh) 1987;114:41–6. https://doi.org/10.1530/acta.0.1140041.
6. Loucks AB, Heath EM. Induction of low-T3 syndrome in exercising women occurs at a threshold of energy availability 1994:R817–23. https://doi.org/10.1152/ajpregu.1994.266.3.R817.
7. Kahaly GJ, Kampmann C, Mohr-Kahaly S. Cardiovascular Hemodynamics and Exercise Tolerance in Thyroid Disease. Thyroid 2002;12:473–81. https://doi.org/10.1089/105072502760143845.
8. Barahona MJ, Mauri A, Sucunza N, Paredes R, Wägner AM. Hypothyroidism as a cause of rhabdomyolysis. Endocr J 2002;49:621–3. https://doi.org/10.1507/endocrj.49.621.
9. Ciloglu F, Peker I, Pehlivan A, Karacabey K, İlhan N, Saygin O, et al. Exercise intensity and its effects on thyroid hormones. Neuroendocrinology Letters 2005;26:830–4.
10. Mainenti MRM, Vigário PS, Teixeira PFS, Maia MDL, Oliveira FP, Vaisman M. Effect of levothyroxine replacement on exercise performance in subclinical hypothyroidism. J Endocrinol Invest 2009;32:470–3. https://doi.org/10.1007/bf03346488.
11. Hackney AC, Dobridge JD. Thyroid hormones and the interrelationship of cortisol and prolactin: influence of prolonged, exhaustive exercise. Endokrynol Pol 2009;60:252–7. https://doi.org/https://doi.org/10.5603/ep.25461.
12. Almandoz JP, Gharib H. Hypothyroidism: Etiology, Diagnosis, and Management. Medical Clinics of North America 2012;96:203–21. https://doi.org/10.1016/j.mcna.2012.01.005.
13. Salvatore D, Simonides WS, Dentice M, Zavacki AM, Larsen PR. Thyroid hormones and skeletal muscle — new insights and potential implications. Nat Rev Endocrinol 2013;10:206. https://doi.org/10.1038/nrendo.2013.238.
14. Bansal A, Kaushik A, Singh C, Sharma V, Singh H. The effect of regular physical exercise on the thyroid function of treated hypothyroid patients: An interventional study at a tertiary care center in Bastar region of India. Archives of Medicine and Health Sciences 2015;3:244. https://doi.org/10.4103/2321-4848.171913.
15. Onsori M, Galedari M. Effects of 12 weeks aerobic exercise on plasma level of TSH and thyroid hormones in sedentary women, European Journal of Sports and Exercise Science 2015, Vol. 4. https://doi.org/10.15561/20755279.2021.0604.
16. Park SH, Song MY. Effects of aerobic and anaerobic exercise on spatial learning ability in hypothyroid rats: a pilot study. J Phys Ther Sci 2016;28:3489. https://doi.org/10.1589/jpts.28.3489.
17. Persani L, Brabant G, Dattani M, Bonomi M, Feldt-Rasmussen U, Fliers E, et al. 2018 European Thyroid Association (ETA) Guidelines on the Diagnosis and Management of Central Hypothyroidism. Eur Thyroid J 2018;7:225–37. https://doi.org/10.1159/000491388.
18. Masaki M, Koide K, Goda A, Miyazaki A, Masuyama T, Koshiba M. Effect of acute aerobic exercise on arterial stiffness and thyroid-stimulating hormone in subclinical hypothyroidism. Heart Vessels 2019;34:1309–16. https://doi.org/10.1007/s00380-019-01355-8.
19. Ylli D, Klubo-Gwiezdzinska J, Wartofsky L. Exercise and Thyroid Function. Contemporary Endocrinology 2020:85–108. https://doi.org/10.1007/978-3-030-33376-8_6.
20. Lankhaar JAC, Kemler E, Hofstetter H, Collard DCM, Zelissen PMJ, Stubbe JH, et al. Physical activity, sports participation and exercise-related constraints in adult women with primary hypothyroidism treated with thyroid hormone replacement therapy. J Sports Sci 2021;39:2493–502. https://doi.org/10.1080/02640414.2021.1940696.
21. Tenyaeva E, Turova E, Golovach A, Badtieva V, Artikulova I, Vermeir P, et al. 454 The influence of subclinical hypothyroidism on physical performance of elite athletes. Br J Sports Med 2021;55:A173–A173. https://doi.org/10.1136/bjsports-2021-ioc.415.
22. Akgül MŞ, Baydil B. Thyroid hormone responses to acute aerobic exercise. Physical Education of Students 2021;25:359–63. https://doi.org/10.15561/20755279.2021.0604.
23. Leko MB, Gunjača I, Pleić N, Zemunik T. Environmental Factors Affecting Thyroid-Stimulating Hormone and Thyroid Hormone Levels. International Journal of Molecular Sciences 2021, Vol 22, Page 6521 2021;22:6521. https://doi.org/10.3390/ijms22126521.
24. Priyanka Yadav, Rituraj Verma. Impact of Aerobic and Resistance Training on Thyroid-Stimulating Hormone in Hypothyroidism. J Pharm Negat Results 2022:1751–62. https://doi.org/10.47750/pnr.2022.13.s06.231.
25. 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;83:523–32. https://doi.org/10.1080/00365513.2023.2286651.
26. Vuletić M, Kaličanin D, Barić Žižić A, Cvek M, Sladić S, Škrabić V, et al. Occupational Physical Activity and Regular Exercise Are Inversely Correlated with Thyroid Function in Patients with Hashimoto’s Thyroiditis. Diseases 2024, Vol 12, Page 281 2024;12:281. https://doi.org/10.3390/diseases12110281.
27. Wrońska K, Hałasa M, Szczuko M. The Role of the Immune System in the Course of Hashimoto’s Thyroiditis: The Current State of Knowledge. International Journal of Molecular Sciences 2024, Vol 25, Page 6883 2024;25:6883. https://doi.org/10.3390/ijms25136883.
28. 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;24:1277. https://doi.org/10.1186/s12889-024-18768-4.
29. Skrzypiec-Spring M, Pokrywka A, Szeląg A, Zembroń-Łacny A. Autoimmune Thyroid Diseases and Physical Activity and Sports—More Unknowns than Facts. Biomedicines 2025, Vol 13, Page 2352 2025;13:2352. https://doi.org/10.3390/biomedicines13102352.
30. Antoniou S, Michaelides M, Tymvios C, Ellina E, Parpa K. The impact of regular moderate-to-intermediate intensity exercise on controlled Hashimoto’s diseased and/or hypothyroid female patients on thyroid hormones, resting metabolic rate, and heart rate variability: A pilot study. Sci Sports 2025;40:546–53. https://doi.org/10.1016/j.scispo.2025.03.002.
31. Kalinowski S, Kadłubek S, Woźniak J, Kapturska N, Kamiński J, Sikora D, et al. Physical Activity, Diet and Overweight in Hashimoto’s Thyroiditis: A Current Literature Review. Quality in Sport 2025;47:66615. https://doi.org/10.12775/qs.2025.47.66615.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aleksandra Skórka, Małgorzata Dokurno, Rafał Kasperek, Paulina Matyla, Karolina Brankowska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 48
Number of citations: 0
