meme showing a woman lying down on the grass with words Hashimoto's Disease the tired that sleep can't cure.

Hashimoto’s Disease and Pilates

Hashimoto’s Disease and Pilates. Hashimoto’s disease is a thyroid disease that is now considered the most common Autoimmune disease. (Beynon, & Pinneri, 2016). It is a disease that I have, and it took years for me to be taken seriously and receive a proper diagnosis. During that time, my health deteriorated dramatically, and even now I struggle to get a doctor to properly review and consider how the disease and its symptoms impacts on my quality of life.  Pilates has been one of my successful tools in managing Hashimoto’s disease.

In this article we will explore

// the anatomy of the thyroid 

// the physiology of the thryoid hormones

// what is Hasmimoto’s disease

// how the disease affects movement 

// some movement ideas for clients and a studio.

If you are wanting to go deeper and learn more about this disease we have released a detailed online course on the topic, with detailed explanations, repertoire and flow classes.


What is the thyroid?

The thyroid is a butterfly shaped organ located in your throat and sits around your trachea. Whilst small this organ plays an essential role in the production and maintenance of hormones associated with metabolism and calcium homeostasis. The thyroid works in conjunction with the anterior pituitary and as such helps with the regulation of metabolism, protein synthesis and growth hormone.

The anterior pituitary is located in your brain, and is a major part of our hormone systems. The pituitary produces a substance called thyroid stimulating hormone (TSH) when the thyroid hormone levels are too low in the body. The idea is that the anterior pituitary and thyroid are working in a constant feedback loop to create balances in the three main hormones of the thyroid.

thyroid gland

Thyroid gland

What are thyroid hormones?

There are three main hormones associated with the thyroid:

// Triiodothyronine (T3) – this hormone is essential in metabolism, growth, temperature regulation and even heart rate.

// Thyroxine (T4) – this hormone is produced by the thyroid and then broken down into T3 by our organs.

// Calcitonin – this hormone regulates calcium rates in the body.

As you can see these hormones are pretty important for bone, muscle nerve function.

To learn more about these hormones and the HPA axis we have explained the details and given some simple ways of undertsanding the principles in our online course.

What is Hashimoto’s disease and how it relates to the thyroid?

Hashimoto’s disease is an autoimmune disease in which the body starts to destroy the tissues of the thyroid leading to imbalances of the thyroid producing hormones. The changes mean that the thyroid enlarges but cannot produce sufficient hormones. Why the disease occurs is not fully understood but it is known that it has a high correlation with celiac disease and has genetic links.

What are the symptoms of Hashimoto’s disease

// rapid weight gain

// loss of hair

// intolerance to cold

// poor memory

// tiredness

// swelling of face and limbs from a fluid build up

// nerve problems eg carpel tunnel

// slowed heart beat 

// slowed movements and reflexes

// bone density problems

The disease is normally identified through blood tests and it is important to work with an endocrinologist to ensure the correct hormone balance is achieved and restored.

What about diet?

Diet does play an important role in Hashimoto’s disease, with a significant amount of people with the disease also having celiac disease. 

Other important nutritional aspects of diet and thyroid include iodine and goitrogenic foods, see table below. Essentially the thyroid requires iodine for the production of thyroid hormones. Iodine is found in seafood and its absence has been noted as contributing to a number of diseases eg cretinism.

Accordingly, working with a good naturopath, dietitian or nutritionist is important to help people with Hashimoto’s disease. The table below, details a lot about various foods and I don’t expect you to fully understand the actions. However, it highlights how important it is for you to talk to an expert about these foods and a balanced diet as they do affect thyroid function, and are not often part of a discussion with your local GP.

Natural substances Action
Millet, soy impairs thyropreroxidase activity
Cassava, sweet potato, sorghum inhibits iodinethryoidal uptake
Babussu conconut, mandioca inhibits thyroperoxidase
cruciferous vegetables, cabbage, cauliflower, brocoli, turnips, canola impairs iodine, throidal uptake
Seaweed (kelp) inhibits release of throidal hormones
malnutrition increasesTSH stimulation 
iron deficiency reduces heme-dependent thyroperoxidase thyrodial activity 


How does Hashimoto’s disease affect movement?

Factors that need to be considered when working with a client with Hashimoto’s disease:

// Memory is impaired and so clients can forget appointments, exercises or activities. These clients might need to have written notes or electronic reminders to help keep them organised. Be patient with them about not remembering the order of exercises, gently prompt them or give them a list as a reminder. Important aspects of memory and learning as well as strategies are discussed in more detail in the online course Introduction to Neuroanatomy

// Hypothyroidism is associated with impaired blood flow to skeletal muscle under whole body exercise conditions. It is unclear whether poor cardiac and/or vascular function account for blunted muscle blood flow.(Bausch & McAllister 2002). This means that muscle power and tendon reflex responses are also very slow. It is not simply a matter of making the person work harder, because if you overload them they are more likely to injure themselves because they are lacking coordination and control. Remember to take things slow and pace the person to their abilities as they build strength and as the thyroid returns to regulation they will get stronger. Just remember not to undermine the person’s self efficacy whilst they are seeking to achieve thyroid regulation. These are discussed and explored in more detail in our Hashimoto’s Disease course

// The slower heart rate also means that blood flow and fluid flow is reduced, meaning that the person retains a lot more fluid. The increase in fluid and its affect on its immune system is discussed in this earlier blog.

// Muscle contractions require calcium, and when the thyroid is not working calcitonin is not being produced and results in poorer muscle contractions and can lead to greater overload on tendons. It is noticeable that frozen shoulder (a.k.a. adhesive capsulitis) is often associated with autoimmune conditions like Hashimoto’s disease. 

Remember that when you are working with tendons it is important to graduate the load on the tendon. Some of the principles of working with tendon injuries is discussed in a previous blog.

// When the thyroid is not working a person is at higher risk of developing osteoporosis.  It is therefore important to remember that a person who has Hashimoto’s disease should be checked for osteopenia or osteoporosis. If the person is not sure what their bone density status is then err on the side of caution until you are certain. Remembering that one of the most important strategies for osteoporosis is dealing with fall’s prevention. Our detailed course about balance will give you some great ideas on working and improving the balance systems.

// A person with Hashimoto’s is more likely to be susceptible to the cold and may need to moderate the studio environment to a person’s temperature tolerance. If you live in the tropics that means you will need to have air conditioning on a bit higher for some clients. My Canadian friends laugh at how seriously I take the cold, but even 10 degrees C (50 Degrees F)  can be brutal to someone with Hashimoto’s disease.

// Skin is also dryer and often a little more fragile for those people with Hashimoto’s disease. This means that as teachers you need to keep your nails short and avoid too much bling as it might scratch or cut the person’s skin. When a person has an autoimmune condition their healing can be compromised and so a simple scratch can become easily infected.

Some of my favourite movements when my thyroid is not working well include:

Unloading the tendon

Some simple strategies to unload the tendon whilst working on strength.

Glisse on the CoreAlign ( from manual 4) as it helps me to work on my reaction time. It encourages me to focus and slowly build reaction speed without injuring myself. It also helps on improve balance. In the Hashimoto’s Disease course we will take you through a 30 minute flow class on the Core Align ( with options to apply this to the Reformer) on dealing with reaction time. The flow class is included in the Hashimoto’s online course.

Incorporating strength work, incorporating many ideas on the WundaChair and the Trapeze table, an image below is one such idea. Once again the full 30 minute class is included in the Hashimoto’s course . This class can also be purchased directly from our on-demand class options.

Above is some of the strength ideas from our Hashimoto‘s disease course.


L. Bausch and R. M. McAllister
Address of author: Department of Anatomy and Physiology, Kansas State University, 224 Coles Hall, Manhattan, KS 66506, USA Received for publication: May 28, 2002.

Beynon, M. E., & Pinneri, K. (2016). An Overview of the Thyroid Gland and Thyroid-Related Deaths for the Forensic Pathologist. Academic forensic pathology6(2), 217–236.

Caturegli P, De Remigis A, Rose NRAutoimmun Rev. 2014 Apr-May; 13(4-5):391-7.

Costanzo L.S. Thyroid Hormones. In: Cicalese B., editor. Physiology. 4th ed. Philadelphia: Saunders Elsevier; 2010. p. 401–9. [Google Scholar]

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