How To Train If You Have Hypothyroidism or PCOS

By Dr. Brooke Kalanick

Training Modifications for Hashimoto's and Hypothyroidism

If you have Hashimoto’s or thyroid trouble, chances are one or more of the following scenarios will sound familiar when it comes to your workouts:

  • You can’t muster the energy to train at all.
  • You can train for a few days, only to hit a wall and need several days to recover.
  • You train regularly, but you’re getting absolutely nowhere with your goals.

Ladies, I feel you here. Of all the women with whom I work, the ones who struggle the most to train consistently are those of you with Hashimoto’s or hypothyroidism.

I assure you: It’s not you, it’s your hormones. A few unique aspects of hypothyroidism make exercise particularly dicey for you.

First, if you have a low-functioning thyroid your metabolism runs slower, plain and simple. You’re fatigued, and you don’t have the stamina to work out regularly. Working with your doctor to improve your energy and stamina is a top priority.

Work with your doc to ensure that you’re getting enough T3 (the active form of thyroid hormone, made from T4) and that you’re not losing it to various mechanisms, such as over-conversion to reverse T3 due to stress, low T3 regeneration in the gut from poor bacterial balance or inadequate free, active T3 levels due to estrogen troubles.

overtraining-woman-crossfit-type-gym-450x338When you’re running low thyroid, not only do you practically have to drag yourself to the gym, you’re also at risk for tendonitis, pain, and nagging, injuries that refuse to heal.

Shoulders, knees, ankles, hips, wrists — all of these can be trouble spots if you are low thyroid and put them under stress with repetitive use.

This can, of course, show up as carpal tunnel issues if you use a computer mouse all day, but repetitive motion exercises in your workouts can also be a problem.

Exercise choices like spinning or high-rep/low-weight strength training can be a double whammy for the wiped-out, hypothyroid woman due to tons of repetitive movement of the hips, knees, and shoulders, a high cortisol demand, and a concomitant lessening of active thyroid hormone. OK, that’s actually a triple whammy.

Beyond the physical injuries and tendonitis, women with Hashimoto’s suffer from a deeper, biochemical injury of sorts: too much oxidative stress. To understand why, we have to talk about glutathione.


Glutathione acts as an immune modulator and antioxidant and is important in liver detoxification and metabolization of substances like alcohol. This little peptide whose name you may not even know how to pronounce is a big player in how well you feel, how frequently and severely you “crash,” and how much of a struggle it is to lose fat with Hashimoto’s.

Glutathione is considered our master antioxidant. It helps us deal with the ongoing oxidative stress of living, metabolizing, and interacting in our modern world. For those of you with autoimmunity like Hashimoto’s, you have an additional stress: simply having autoimmunity. Part of the fall-out of autoimmunity is oxidative stress, or the generation of free radicals.

What Is Oxidative Stress, and Why Is It So Damaging?

Oxidation is the removal of electrons from a molecule which creates a free radical. This free radical is then desperate to steal another electron from a nearby molecule, and without someone stepping in (i.e. our internal antioxidant systems like glutathione) a chain reaction of oxidation and electron stealing quickly gets out of control.

A commonly used example of oxidation is rusting metal — and yes, that’s literally what’s happening in our bodies when oxidation happens.

Oxidation is a normal process and part of how we interact with our world as well as engage in the complex biochemistry going on all the time within our bodies.

The problem is that our modern life stressors have us in contact with more oxidation, and our antioxidant systems can easily get wiped out. And, if you have autoimmunity like Hashimoto’s, your glutathione defenses are incredibly compromised.

As an unquenched free radical goes on the rampage, our internal antioxidant systems should be donating electrons, cutting off this chain reaction. But when our defenses are overwhelmed, or we have Hashimoto’s and lack robust glutathione systems, the free radicals from oxidative stress rip through our bodies like a tornado. What gets particularly torn to shreds are our mitochondria – the internal cellular powerhouses that convert our nutrients and food to energy.

Know what else generates quite a lot of free radicals and oxidative stress? Exercise.

It’s one of those “good” types of stress, but it’s stressful nonetheless — especially if you have depleted antioxidant systems due to Hahsimoto’s or any other type of autoimmunity (rheumatoid arthritis, lupus, Crohn's, celiac, etc).

This is one of the main reasons why many women with Hashimoto’s feel they can’t recover well from exercise, often despite following a sound nutrition strategy. It’s not just about more getting more rest or eating more carbs. It’s about this overwhelming burden of oxidative stress that the body just can’t handle.

This can make it extremely challenging to keep up with a regular exercise routine. Often, some women will find that they need several days to recover after a training session, or if they push themselves too hard, they feel like a wreck for days after.

It’s wise to work with someone who can assess this internal system. A few things are known to help, such as whey protein (provided you are not sensitive, which many Hashimoto’s sufferers are), and taking n-acetyl cysteine (NAC, a precursor to glutathione), or more recently, acetylated forms of glutathione, which appear to be absorbed better than glutathione supplements of the past.

Once you have more glutathione, you have to be able to recycle, regenerate, and continue to use it lest it can also become an oxidative stressor. Nutrients like alpha lipoic acid, glutamine, cordyceps, and milk thistle are helpful here for recycling the glutathione molecule and keeping this system humming along.

How to “Push” When You’re Healing Adrenal and Thyroid Issues

There’s a fine line between overdoing it and not doing enough when you’re dealing with hormonal issues. Stress is fickle. It’s necessary to create some stress, or the hormonal signals for fat burning and muscle growth won’t be triggered, and you won’t make any progress.

But if you push too hard, you end up setting yourself back or just continuing to push your system, which is simply unable to recover.

Over-training will always set you back if you have thyroid or cortisol issues. It may go something like this: You have a good day, so you go for a walk, then train. You do some sprints or head back to the gym for another class, or decide you don’t need your scheduled rest day. You end up pushing too hard since you were feeling great … and then you feel bad again.

I can’t stress this enough: Avoid the urge to push too hard.

Instead, increase your exercise a little bit at a time. Try adding just one more set of a strength training exercise, or just one to five more minutes to your routine instead of another 45 to 60 minutes. Add just one more day of training per week before trying two-a-days.

Test yourself before you wreck yourself! The setbacks are always frustrating, so find ways to do a gentle nudge instead of pushing too hard.

And as I always say: listen to your hormones talking to you via your ACES (appetite, cravings, energy and sleep). While these cues are always helpful, for some women it’s wise to get more concrete data using heart rate variability (HRV) tools such as BioForce or Elite HRV.

HRV tools assess how well your body is coping and adapting to stress each day. It’s an excellent tool to gauge how hard you can train, or if you need another rest day instead.

Training Modifications for PCOS

I’ve previously discussed the variance in body types with PCOS and my framework for understanding the differences. One key difference is that the “lean” type tends to be more resistant to storing body fat and better able to shuttle nutrients into the muscle, while the “heavy” type is great at storing fat in fat tissue and less effective at getting nutrients into the muscle tissue. This is all due to each PCOS woman’s degree of insulin resistance and in which tissues are more resistant (muscle or fat).

We are constantly in a state of remodeling, with our hormones using resources and directing an intricate dance throughout the day, building up and breaking down, anabolism and catabolism. This is true of all of us, but the effects are more dramatic in women with PCOS.

Because of this, many women with PCOS feel that they easily get “bulky” from training and struggle to lose fat. While this can be a bit confusing, remember that insulin resistance plays a role in PCOS to varying degrees, but all women with PCOS tend to be more anabolic, therefore their bodies are overall able to put on muscle and fat easier than their hormonally balanced girlfriends.

The woman with PCOS who feels she puts on muscle easy and tends to feel “puffy” or “bulky” when she trains more needs to do a couple things to get better results.

Nutrition is at the top of this list. Dialing in the diet can make a big difference. I know this is a post about exercise, but finding your “unique carb tolerance” (UCT), investigating any problematic foods or sensitivities, and balancing your ACES is job number one if you’re trying to make body composition changes.

Next, consider more exercise. I know we often talk about doing less exercise (which is the best strategy for some women), but the more insulin-resistant you are, the more your body is in “building” mode, and the more exercise it will tolerate.

You don’t have to do crazy-intense exercise, just more activity in general. Lots of walking and even some longer duration cardio is often very helpful for women with insulin resistance and PCOS.

When it comes to strength training, if your adrenals are doing OK, you’ll do well with metabolic conditioning and HIIT.

If your adrenals are struggling a bit, as is often the case—women are rarely dealing with just one hormone issue—I often recommend two, more traditional strength training sessions per week with more rest, and one metabolic training session per week. The other days should be a balance of cardio that works for you, between HIIT and longer, steady state cardio—and lots of walking, always.

If your body type is the leaner, more fat-resistant PCOS type, you do have to watch a constant cortisol push from exercise. You will not tolerate the metabolic conditioning and HIIT as well as the heavier body type counterparts. You’ll do well with heavier weights, two to three times per week and a lot of walking.

Now, before you rush off to the gym to manipulate your hormones and PCOS, I want to take a minute to remind you of something I’ve learned the hard way: embrace the body you have.

I have PCOS and, genetically speaking, I inherited bigger thighs — and I have always wanted to make them smaller. Running my way into exhaustion only made my hormone issues (cortisol, insulin, and thyroid) worse.

After finally embracing these big, strong thighs, I started lifting heavier — and yes, I put on muscle and they got a touch bigger. But I have more energy and am sleeping better.

And while my legs may be a bit bigger, they are actually leaner than ever (even with a less-than-perfect diet and sleep schedule these days). They were smaller when I was a runner, but I was plagued with injuries, I hated doing it, and I was easily wiped out from excessive cardio.

Today, I am more at peace with the body I have always fought against.

When In Doubt, Tune In to Yourself

It can take time to understand and heed your hormones’ call, but when you don’t, you are your own worst enemy. If you’ve been reading my articles, you know what we need to do is be our own best friend.

Sometimes you have to tune into a hormonal signal, and sometimes you have to tune into your mental chatter. When you aren’t sure if you’re listening to your body or not, start to listen closer to the voice in your head. Is it the voice of your own worst enemy, or your biggest cheerleader?

The worst enemy voice is a bit of a slave driver. It uses your insecurities to motivate and berate you. It says things like, “You have to go to the gym because you’re blah blah blah.” Or it may sound like a bit of a whiner, and try to talk you out of what’s best for you by saying things like, “You don’t have to go to the gym. You worked so hard yesterday.” Or, “Go ahead and drink more wine, you trained really hard today…”

The best friend voice, on the other hand, makes no excuses. She simply tells you that you need to rest. Not because you did so much yesterday, but because it makes sense for you right now, today.

All women need to stop battling themselves and get on their own side, but in particular, women with hormonal challenges like PCOS and Hashimoto’s will feel the effects even more significantly if they don’t. Both conditions can make weight loss, good energy, and even health seem elusive.

Paying special attention to work with these unique issues instead of against them will not only get you better results, it will stop you from pushing your system into further disarray.

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About the author:  Dr. Brooke Kalanick

Dr. Brooke Kalanick earned her Doctorate in Naturopathic Medicine from Bastyr University. Known as “The Hormone Whisperer,” Brooke's balanced approach to health, using both conventional and alternative therapies, allows her to successfully treat patients with Hashimoto’s Hypothyroidism and PCOS as well as other female hormone imbalances. Learn more about Dr. Brooke on her website and connect with her on Facebook and Twitter.

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