Structured Exercise Benefits in Euthyroid Graves’ Disease: Improved Capacity, Fatigue, and Relapse Original paper
Researched by:
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Giorgos Aristotelous
ID
Giorgos Aristotelous
Giorgos — BSc, MSc. Giorgos is an exercise scientist whose training and professional practice sit at the intersection of human performance, clinical health, and emerging microbiome science. He holds a BSc in Sports Science & Physical Education from Aristotle University (2012) and an MSc in Exercise & Health from Democritus University (2016), where his graduate work explored physiological adaptations to training across the lifespan. Now in his 15th year of practice, Giorgos pairs evidence-based coaching (ACSM-CPT, NSCA, USA Weightlifting) with a research-driven interest in how physical activity, body composition, and musculoskeletal integrity shape—and are shaped by—host–microbiome dynamics.
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Giorgos Aristotelous
Researched by:
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Giorgos Aristotelous
ID
Giorgos Aristotelous
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Giorgos Aristotelous
What was studied?
This retrospective case-control study investigated the short- and long-term effects of a structured exercise program on euthyroid patients with Graves’ disease (GD). The primary outcomes included aerobic capacity, fatigue, thyroid hormone levels, time to anti-thyroid medication withdrawal, and relapse rates. Participants were divided into an exercise group (n=62) who completed a 3-week structured program involving daily supervised walking, stretching, and resistance exercises, and a control group (n=62) who engaged in unstructured leisure activities. Both groups were evaluated at admission and discharge, with long-term follow-up over 24 months.
Who was studied?
The study included 124 euthyroid patients (62 per group), aged 20–40 years, with previously diagnosed Graves’ disease, maintained on stable anti-thyroid medication for at least one month. All participants met inclusion criteria related to hormone levels, exercise tolerance, and clinical stability. Patients were selected from a pool of ~700 medical records at a Serbian thyroid rehabilitation institute. Gender was matched (31 men and 31 women in each group), and follow-up data on medication cessation and relapse were available for all.
Most important findings
Exercise significantly improved aerobic capacity, reduced fatigue, and favorably influenced the course of GD. The key findings are summarized below:
| Parameter | Exercise Group | Control Group |
|---|---|---|
| Peak VO₂ (ml/kg/min, Admission→Discharge) | 23.6 → 39.6 (+68%) | 26.2 → 27.1 (NS) |
| T4 Change (nmol/L) | ↓ from 117.4 to 105.7 (p=0.038) | ↓ from 119.1 to 115.3 (NS) |
| TSH Change (mU/L) | ↑ from 3.2 to 3.5 (trend, p=0.071) | No change |
| Severe Fatigue (Admission→Discharge) | 71% → 0% | 49% → 34% |
| Medication Withdrawal ≤6 months | 84% | 18% |
| Relapse within 12 months | 29% | 72% |
Additionally, exercise reduced resting heart rate, extended exercise test duration, and showed parallel improvement in fatigue scores. The immunological discussion suggests exercise may favorably shift immune balance toward TSH receptor–blocking antibody dominance, similar to remission patterns seen in pregnancy.
Key implications
This study provides preliminary yet compelling evidence that structured exercise can improve physical function and immunological outcomes in GD beyond standard pharmacotherapy. The reduction in relapse and earlier medication withdrawal suggest a role for exercise in disease modification. Mechanistically, exercise may modulate the neuroendocrine-immune axis, potentially shifting the TH1/TH2 balance and promoting the production of TSH receptor–blocking antibodies. These findings support integrating supervised physical activity into the rehabilitative care of GD patients, though prospective randomized controlled trials are needed to confirm causality and optimize protocols.