Thyroid Conditions and Physiotherapy: A Holistic Approach to Symptom Management by Megan Schneider Senior APA Physiotherapist
Thyroid disorders can vary in presentation, here we are going to focus on the two most common: HYPOthyroidism and HYPERthyroidism. The cause for both is commonly a result of autoimmune diseases like Hashimoto's and Graves’ disease, or less commonly, Iodine deficiency (mostly in countries located further from the ocean). Thyroid conditions affect millions of people globally and while pharmacological treatment remains essential, physiotherapy is emerging as a valuable tool in managing symptoms and improving quality of life.
What does our thyroid do?
The thyroid is essential for production of thyroid hormones. Thyroid hormones, primarily T3 and T4 are hormones that are critical for controlling body functions including: metabolism, growth and development, cardiovascular function, nervous system function, body temperature regulation, digestive function, and skin and hair health. Having imbalances in thyroid hormones, predominantly resulting from autoimmune conditions in Australia, can cause symptoms including but not limited to:
Hypothyroidism (Hashimotos): fatigue, weight gain, cold intolerance, joint stiffness, depression, poor memory and concentration, poor hearing, throat hoarseness, slow heart rate, hair loss, constipation, shortness of breath, menorrhagia (heavy menstrual bleeding).
Hyperthyroidism (Graves): anxiety, heat intolerance, muscle weakness, tremors, fatigue, increased heart rate, irregular menstruation, unintentional weight loss, difficulty with sleeping.
How can Physiotherapy help in these cases?
It is important to understand that Physiotherapy CANNOT resolve a thyroid issue; however, it CAN help to address musculoskeletal, metabolic, and psychological symptoms associated with thyroid dysfunction.
Physiotherapists can help with manual therapy techniques and help to prescribe appropriate exercises to suit your individual needs. Exercise can help manage the symptoms of thyroid disorders in a variety of ways, some of which we will dive into below:
Managing Fatigue:
Exercise enhances the body's ability to circulate blood and oxygen, the increase in oxygen supply supports the process by which the body creates energy producing cells. Regular exercise also encourages the growth of mitochondria, which sit within muscle tissue. Mitochondria are crucial in converting glucose and oxygen into energy for the body, thus the increase in oxygen supply as well as increase in mitochondria both contribute to an overall increase in energy supply for the body, reducing levels of fatigue. A study found that sedentary adults who began a regular exercise routine reported significantly reduced fatigue compared to those who remained inactive.
Reducing stiffness:
There are a range of physiotherapy interventions that can help reduce stiffness through joints and muscles. Starting with exercise intervention:
- Regular exercise enhances the elasticity of muscles and tendons, which helps to improve joint range of motion, and reduce stiffness. This occurs through collagen remodelling, whereby regular mechanical loading from exercise stimulates fibroblasts (a cell that contributes to the formation of connective tissue) to produce new collagen, improving structural integrity and elasticity of tissue.
- Aerobic and resistance exercise increases blood circulation, delivering oxygen and nutrients to muscles and joints while removing metabolic waste. This supports cellular repair and regeneration, helping to maintain pliability and resilience of connective tissue.
- Stretching and eccentric strengthening promote elongating muscle fibres, increasing sarcomere (the basic contractile unit of a muscle fibre) length, which enhances flexibility and reduces resistance to movement.
- Synovial fluid production is stimulated during exercise, which helps to lubricate joints reducing friction and resistance to motion.
- Exercise leads to neuromuscular adaptation by improving communication between the nervous system and muscles. This enhances coordination reduces the sensation of stiffness, and over time leads to more efficient movement patterns and less muscle tension.
- Reduction of muscle atrophy through maintained exercise ensures maintained muscle length and flexibility, reducing stiffness.
As well as exercise interventions for stiffness, physiotherapists can utilise a range of manual therapy skills to help reduce muscle and joint stiffness one may be experiencing. This may include:
- Soft tissue massage
- Joint mobilisations
- Trigger point release
- Dry needling
Weight management
Hypothyroidism slows down your metabolic rate, making it harder to burn calories. Adding exercise into your daily routine (especially resistance-based exercise) will increase your daily energy expenditure through active movement as well as increasing your base metabolic rate. Increases in muscle mass leads to improvements in the body’s metabolic efficiency and overall ability to metabolise fat and carbohydrates through increased mitochondria in the muscle cells, enhancing oxidative capacity and fat utilisation during rest and exercise. This shift helps the body rely more on fat stores for energy, promoting fat loss. Exercise can also help to regulate hormones like insulin and leptin, which are often disrupted in hypothyroidism. This can improve your body’s ability to burn fat and manage hunger cues.
Constipation
Physical activity stimulates intestinal contractions, helping move stool through the colon more efficiently. A study on gastroenterology found that regular exercise significantly improved bowel movement frequency and consistency.
Depression
Exercise is proven to stimulate the release of mood-enhancing neurotransmitters such as serotonin, dopamine, and norepinephrine, which are chemicals that play a key role in regulating mood, motivation, and emotional wellbeing. Exercise also helps to reduce levels of cortisol (the stress hormone). The combination of increasing the availability of mood elevators and decreasing stressors can alleviate symptoms of depression, anxiety and physiological distress following physical activity
Research has shown that 15 minutes of running or 1 hour of walking daily can reduce the risk of major depression by 26%.
Post thyroid surgery management
Thyroid surgery involves incisions in the neck area, which can lead to muscle tightness, scar tissue formation, and reduced range of motion in the neck. Physiotherapy can help manage these through stretching, mobilisation and massage techniques to restore neck flexibility, reduce discomfort, and improve posture.
What exercises should I be doing?
Exercise prescription to help manage thyroid conditions should be individualised for each person, which your physiotherapist can help do for you. Yet here are some general suggestions for recommended exercise interventions for both hypothyroidism and hyperthyroidism.
Hypothyroidism:
- Low impact aerobic exercise: walking, swimming, cycling (3-5 time/week)
- Strength/resistance training (2-3 times/week)
- Flexibility/mobility exercise: yoga and/or Pilates
- Balance exercises: tai chi and/or balance exercises
Hyperthyroidism
- Strength/resistance training (2-3 times/week)
- Breathing exercises
- Flexibility/mobility exercise: yoga and/or Pilates
- Mind-body practices: yoga and/or tai chi
Conclusion
Physiotherapy offers a safe, evidence-based complement to medical treatment for thyroid conditions. Whether managing fatigue, rebuilding strength, or supporting mental health, tailored physical therapy can significantly enhance well-being.
References:
American Physical Therapy Association. (n.d.). Role of physiotherapy in post-surgical recovery. https://www.apta.org/patient-care/interventions/physical-therapy
Bohm, S., Mersmann, F., & Arampatzis, A. (2020). Human tendon adaptation in response to mechanical loading: A systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Medicine - Open, 6(1), 7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7069454/
Davis Phinney Foundation. (2025, January 30). Exploring exercise to manage fatigue. https://davisphinneyfoundation.org/exploring-exercise-to-manage-fatigue/
Golen, T., & Ricciotti, H. (2021, July 1). Does exercise really boost energy levels? Harvard Health Publishing. https://www.health.harvard.edu/exercise-and-fitness/does-exercise-really-boost-energy-levels
Harvard Health Publishing. (2025, July 2). Use strength training to help ward off chronic disease. https://www.health.harvard.edu/healthbeat/use-strength-training-to-help-ward-off-chronic-disease
Harvard Health Publishing. (n.d.). Physical therapy: How it helps. Harvard Health. https://www.health.harvard.edu/pain/physical-therapy-how-it-helps
Johns Hopkins Medicine. (n.d.). Exercising for better sleep. https://www.hopkinsmedicine.org/health/wellness-and-prevention/exercising-for-better-sleep
Kjaer, M., Magnusson, P., Krogsgaard, M., Boysen, M., Olesen, J., Heinemeier, K., ... & Langberg, H. (2009). Extracellular matrix adaptation of tendon and skeletal muscle to exercise. Journal of Anatomy, 208(4), 445–450. https://pmc.ncbi.nlm.nih.gov/articles/PMC5803609/
Lachman, M. E., Lipsitz, L., Lubben, J., Castaneda-Sceppa, C., & Jette, A. M. (2018). When adults don’t exercise: Behavioral strategies to increase physical activity in sedentary middle-aged and older adults. Innovation in Aging, 2(1), 1–12. https://pmc.ncbi.nlm.nih.gov/articles/PMC6037047/pdf/igy007.pdf
Mayo Clinic Press. (n.d.). The many benefits of resistance training as you age. https://mcpress.mayoclinic.org/healthy-aging/the-many-benefits-of-resistance-training-as-you-age/
Mayo Clinic Staff. (n.d.). Strength training: Get stronger, leaner, healthier. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046670
Mayo Clinic Staff. (n.d.). Thyroid surgery: What to expect. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/thyroidectomy/about/pac-20385162
National Center for Biotechnology Information. (n.d.). Exercise as a treatment for depression. https://www.ncbi.nlm.nih.gov/pmc/resources/citations/8602192/export/
National Center for Biotechnology Information. (n.d.). Voice and swallowing outcomes after thyroid surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMCXXXXXXX/ (placeholder for specific article)
Propel Physiotherapy. (n.d.). How to manage fatigue with exercise. https://propelphysiotherapy.com/exercise/how-to-manage-fatigue-with-exercise/
Wang, Y., Liangjie, J., & Ying, P. (2024). Cellular Feimin enhances exercise performance by suppressing muscle thermogenesis [Data set]. NCBI Gene Expression Omnibus. https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE280845
Zhao, Y.-L., Sun, S.-Y., Qin, H.-C., Zhu, Y.-L., Luo, Z.-W., Qian, Y., & Chen, S. (2024). Research progress on the mechanism of exercise against depression. World Journal of Psychiatry, 14(11), 1611–1617. https://pmc.ncbi.nlm.nih.gov/articles/PMC11572674/pdf/WJP-14-1611.pdf