Lifestyle Interventions in Hypothyroidism: A Systematic Review of Evidence From Exercise, Diet, Yoga, Sleep, and Comprehensive Behavioral Modification

Hypothyroidism is a common endocrine disorder associated with metabolic dysregulation, cardiovascular risk, fatigue, sleep disturbances, and impaired quality of life. Although levothyroxine replacement therapy remains the standard of care, a substantial proportion of patients continue to report persistent symptoms despite achieving biochemical euthyroidism. This systematic review evaluates the evidence on lifestyle interventions—including structured exercise, dietary modification, yoga, stress management, sleep optimization, and comprehensive lifestyle programs—in individuals with hypothyroidism and subclinical hypothyroidism. Electronic databases were reviewed for randomized controlled trials, systematic reviews, and observational studies assessing lifestyle-related outcomes. The findings indicate that lifestyle interventions significantly improve quality of life, fatigue, sleep quality, anthropometric measures, and metabolic parameters, with modest but clinically relevant effects on thyroid hormone profiles. These interventions offer a safe, cost-effective, and patient-centered adjunct to pharmacological therapy and support the integration of lifestyle medicine into routine hypothyroidism management.