Thyroid stimulating hormone (TSH) is produced by the pituitary gland in the brain. It tells the thyroid gland to make and release thyroid hormones into the bloodstream. Thyroid hormones like triiodothyronine (T3) and thyroxine (T4) help control growth, body temperature, heart rate, and metabolism.
When TSH levels are high, it generally indicates that the thyroid gland is underactive or hypothyroid. This means it is not producing enough thyroid hormones. High TSH levels are typically treated with medications that provide the missing thyroid hormones. However, some people wonder if there are lifestyle approaches, like exercise, that can help lower TSH levels.
What is TSH and what do different levels mean?
TSH stands for thyroid stimulating hormone. It is produced by the pituitary gland in response to levels of T3 and T4 in the bloodstream.
– TSH levels below 0.4 mIU/L generally indicate hyperthyroidism, meaning the thyroid gland is overactive and producing too much T3 and T4.
– TSH levels between 0.4-4.0 mIU/L are considered normal and indicate euthyroidism, or normal thyroid function.
– TSH levels above 4.0 mIU/L generally indicate hypothyroidism meaning the thyroid gland is underactive and not producing enough T3 and T4.
The higher the TSH level, the more underactive the thyroid gland. Mild hypothyroidism corresponds to a TSH between 4-10 mIU/L. More severe hypothyroidism is characterized by a TSH above 10 mIU/L.
Doctors will diagnose hypothyroidism based on symptoms as well as TSH and thyroid hormone levels. They will also do additional testing to identify the cause, which is often the autoimmune condition Hashimoto’s thyroiditis.
What causes high TSH levels?
There are several potential causes of an elevated TSH:
– Hashimoto’s thyroiditis: This autoimmune disorder damages the thyroid gland causing it to underproduce thyroid hormones. It is the most common cause of hypothyroidism.
– Thyroid cancer treatment: Surgery, radioactive iodine therapy, or external radiation for thyroid cancer can damage thyroid cells leading to underproduction of hormones.
– Pituitary gland malfunction: The pituitary gland produces TSH. If it is damaged, it may not be able to maintain normal TSH levels.
– Medications: Drugs that treat depression, heart conditions, and cancer can impact thyroid function and raise TSH. Examples include lithium, interferon alpha, and IL-2.
– Aging: Thyroid function declines with age leading to higher TSH levels in older adults.
– Iodine deficiency: Iodine is used to produce thyroid hormones. An iodine deficiency can disrupt hormone synthesis.
– Pregnancy: Hormone changes during pregnancy can cause temporary hypothyroidism and increased TSH.
– Congenital hypothyroidism: Babies can sometimes be born with an underactive thyroid gland and elevated TSH levels.
How is high TSH treated conventionally?
The conventional treatment for an elevated TSH level is thyroid hormone replacement medication. There are two types:
– Levothyroxine (Synthroid, Levoxyl, Tirosint, Unithroid): This provides a synthetic version of the T4 thyroid hormone. It is the standard treatment for hypothyroidism.
– Liothyronine (Cytomel): This provides a synthetic version of the T3 thyroid hormone. It may be preferred when T4 alone does not resolve symptoms.
The goal is to normalize the high TSH by giving the body the thyroid hormones it needs directly. This returns thyroid function to normal and relieves hypothyroid symptoms.
The starting dose is based on factors like age, weight, and TSH level. Doses are gradually adjusted based on follow up TSH testing to maintain the optimal level. Patients with hypothyroidism will need to continue the medication long-term.
Can exercise help lower TSH levels?
Research suggests that exercise may help lower TSH levels in some cases.
One study looked at the impact of 12-weeks of aerobic exercise in women with hypothyroidism being treated with levothyroxine. The results showed:
– The exercise group had significantly lower TSH levels after 12 weeks compared to the control group.
– They were able to reduce their medication doses while maintaining normal TSH levels.
Another study examined the effects of yoga postures and breathing exercises in women with hypothyroidism. After 6 months of practice:
– The yoga group had significantly decreased TSH levels compared to the control group.
– Their levothyroxine doses were reduced by an average of 37%.
A few potential reasons why exercise could lower TSH:
– Improves thyroid hormone sensitivity – Exercise makes body tissues more sensitive to existing thyroid hormones.
– Increases blood flow – Exercise improves blood circulation which enhances thyroid hormone delivery to tissues.
– Reduces inflammation – Exercise lowers inflammatory cytokines that can interfere with thyroid function.
– Releases thyroid hormones from binding proteins – Intense exercise causes release of hormones bound to proteins.
– Improves hormonal regulation – Exercise helps normalize hormonal imbalances that disrupt thyroid function.
So research indicates exercise can lower TSH levels in people with hypothyroidism. However, it is unable to fully normalize TSH without medication. It works best as a complement to thyroid hormone replacement treatment.
What types of exercise may help lower TSH?
Certain types of exercise appear more beneficial for lowering TSH:
– Aerobic exercise – Activities like walking, jogging, cycling, swimming that increase heart rate and oxygen consumption.
– High intensity interval training (HIIT) – Short bursts of intense activity mixed with rest periods.
– Strength training – Lifting weights or bodyweight exercises like push-ups and squats. Building muscle may enhance thyroid hormone sensitivity.
– Yoga – Poses, meditation, and breathing exercises help reduce stress and improve thyroid functioning.
In studies, the amount of exercise has typically been:
– 30-45 mins aerobic exercise 3-5 days per week
– 15-30 mins strength training 2-3 days per week
– 45-60 mins yoga classes 2-3 days per week
Any exercise is good. But getting 150-300 mins per week of moderate exercise seems most beneficial for lowering TSH. A mix of aerobic, strength training, and yoga provides maximum benefits.
Tips for exercising with high TSH levels
Here are some tips for exercising safely and effectively with hypothyroidism:
– Get medical clearance – See your doctor before significantly increasing exercise with uncontrolled hypothyroidism.
– Start slow and easy – Begin with light walking and gradually increase duration and intensity over weeks.
– Listen to your body – Don’t overexert yourself. Scale back if feeling fatigued.
– Exercise consistently – Work out most days of the week rather than 1-2 big sessions.
– Allow rest days – Take 1-2 days off from exercise per week for recovery.
– Wait 3-4 hours after eating – Avoid strenuous exercise within a few hours of a meal.
– Stay hydrated and cool down – Drink water before, during, and after exercise. Finish workouts with stretching.
– Exercise in the morning – This takes advantage of higher energy levels.
– Monitor heart rate and oxygen saturation – Use a fitness tracker to ensure levels remain in target zones.
– Address nutrition – Eat a hypothyroidism-friendly diet to support workouts.
– Consider supplements – Things like iron, vitamin D, B12, and selenium aid energy.
– Adjust medication – Lowering levothyroxine dose may be needed with increased activity.
Are there risks to exercising with high TSH levels?
There are a few potential risks to be aware of:
– Worsening hypothyroid symptoms – High intensity exercise can sometimes make fatigue and muscle aches temporarily worse.
– Cardiovascular strain – Hypothyroidism raises heart rate at lower exercise intensities. This causes earlier aerobic capacity limitations.
– Musculoskeletal injuries – Thyroid hormone imbalance impairs protein synthesis and collagen integrity increasing injury risk.
– Adverse heart rhythms – Untreated hypothyroidism can raise the chance of dangerous arrhythmias during intense exertion.
However, these risks are low in people with mild to moderate hypothyroidism who begin an exercise program at a gentle pace. The benefits generally outweigh the risks when exercised is started appropriately.
Anyone with severe hypothyroidism or symptoms like chest pain, heart palpitations, or dizziness should see a doctor before exercising. With medical guidance, physical activity can be undertaken safely.
Should thyroid medication be adjusted when starting to exercise?
When beginning a new exercise program, levothyroxine dosage may need adjustment. Here are some general guidelines:
– Check TSH before increasing exercise – Get baseline TSH level before changing activity levels.
– Retest TSH after 2-3 months – Check TSH again after establishing consistent exercise routine.
– Consider lowering levothyroxine dose – If TSH is suppressed below normal, the dose may be too high for new activity level.
– Decrease by 12.5-25 mcg increments – Reduce levothyroxine by a small amount, like from 100 mcg to 88 mcg.
– Recheck TSH in 4-6 weeks – Confirm the new dose keeps TSH in the normal range.
– Make additional small dose changes – Further tweaks to levothyroxine may be needed over time.
– Communicate with your doctor – Don’t change medication on your own. Consult your physician for guidance.
The improved thyroid hormone sensitivity from exercise may mean a lower levothyroxine dose is sufficient to maintain normal TSH levels. But dosage changes should always be made under medical supervision.
Are there lifestyle factors other than exercise that affect TSH levels?
Yes, there are other modifiable lifestyle factors that can impact TSH:
– **Stress -** Chronic stress raises cortisol which can interfere with thyroid function and elevate TSH. Stress management helps counteract.
– **Sleep** – Not getting enough sleep disrupts endocrine system regulation. Aim for 7-9 hours per night.
– **Nutrition** – Eat a diet rich in nutrients important for thyroid health like selenium, zinc, B vitamins, vitamin D, iron, and omega-3s. Avoid foods that suppress thyroid function like soy, cruciferous vegetables, gluten, and refined carbs.
– **Toxins** – Minimize exposure to endocrine disruptors like bisphenol A (BPA), phthalates, pesticides, mold, lead, and fluoride which may affect thyroid function.
– **Alcohol** – Heavy and frequent alcohol consumption can increase TSH levels. Limit to occasional moderate intake.
– **Smoking** – Cigarette smoking is linked to higher risk of hypothyroidism. Quitting can help normalize TSH.
A balanced lifestyle approach combining exercise with healthy stress, sleep, nutrition, and toxins avoidance habits can optimize TSH levels.
Should other hormones and biomarkers be tested along with TSH?
Checking additional hormones and biomarkers beyond TSH can provide a more complete picture of thyroid function:
– **Free T4** – Measures unbound thyroxine hormone levels, which can be low when TSH is elevated. Confirms the high TSH is due to hypothyroidism rather than pituitary dysregulation.
– **Free T3** – Unbound triiodothyronine levels which may be low in some hypothyroid patients with continuing symptoms despite normal TSH and T4 levels.
– **Thyroid peroxidase and thyroglobulin antibodies** – Elevated levels indicate Hashimoto’s autoimmune thyroiditis, the most common cause of hypothyroidism.
– **Reverse T3** – High levels of inactive reverse T3 may contribute to persistent symptoms when TSH, T4, and T3 are normal.
– **Vitamin D** – Low vitamin D is associated with hypothyroidism and autoimmunity. Supplements may help normalize thyroid function.
– **Iron studies** – Iron deficiency impairs thyroid hormone synthesis. Treatment can help optimize thyroid hormone levels.
Checking these additional biomarkers provides a thorough assessment of thyroid status rather than just looking at TSH alone. This can help guide appropriate management.
Conclusion
Research indicates that exercise may help lower TSH levels in people with hypothyroidism and high TSH. Aerobic exercise, strength training, high intensity interval training, and yoga are among the types of exercise that appear most beneficial. However, exercise is not able to fully correct thyroid dysfunction without thyroid hormone replacement medication. It serves best as a complementary therapy along with medications.
Lifestyle measures like stress reduction, adequate sleep, a nutritious diet, and avoidance of thyroid-disrupting toxins can also favorably influence TSH. People with hypothyroidism looking to lower their TSH levels should develop a comprehensive plan including both exercise and other healthy lifestyle behaviors. Working with a healthcare provider knowledgeable about integrative thyroid management can help tailor an approach to your specific situation and needs.