Ask the Coach: Thyroid medication and exercise - Part II

Q. I'm wondering if you can share some information about running and the thyroid replacement meds Synthorid and Cytomel.

I was diagnosed several years ago with Graves Disease. I was allergic to the two possible meds that would slow down thyroid production and so the only alternative was to eliminate the thyroid production completely with radiation.

I was able to find a balance fairly quickly with moderate exercise and the direction provided by my endocrinologist. My only issue was gradual weight gain. Over the years I've seen a steady, slow increase in my weight that seems to unaffected by diet and exercise. My endocrinologist has encouraged me to keep up with the workouts and regular walks with my dog that have become the staples of my life.

Two years ago I stepped on a treadmill and a painful, breathless mile turned into the pursuit of a lifetime ... I ran my first marathon this past fall --- I ran Twin Cities 4:43:20, it was very warm and I finished it in good health. I was smiling and having fun the whole way. My fitness level has never been better, but my body fat continues to climb.

I'll be running another marathon on January 15th. The body is a trickster, quickly adapting to the new challenges. I understand the benefits of cross training and switching things up, but I can't get my head around the relationship between running, metabolism and thyroid disease. It's like some big mystery -- I can't find research or articles from other runners and even my endocrinologist who is recognized as one of the best and who has helped me tremendously can offer very little information on the topic.

As my mileage and fitness levels have increased, my body struggles to absorb the thyroid meds. My levels keep coming back very low. We've increased the Synthriod and the endocrinologist trusts me to decide the days I need the Cytomel. I experienced some heart palpitations from the Cytomel on my long runs, so I skip it on those days. I'm not asking for a miracle, just a better understanding.

A. Click here to see Part I of the answer. The Part II answer comes from Libby Burrell, national team program director for USA Triathlon, who has lived with thyroid disease for some 32 years now. At times in her life she has dealt with the disease in the midst of a highly competitive, elite athlete career in South Africa. Her answer is below:

At the height of my competitive swimming career, some 32 years ago, I was diagnosed with an under-active thyroid. In a way this came as a relief because the incredible fatigue and below-par performance in training and racing just made no sense. I was tired of hearing that I was burnt out and over-trained. When the news came, I was actually relieved that I'd be able to take medication to treat the problem and then get back to where I wanted to be as a competitive athlete.

I soon learned that it wasn't that simple and after a few months on the medication I was back to square one. There were days when I was tired from the time I woke up until I went to bed, and other days when I was100 percent. It was there and then that I learned that TSH and Free T4 levels need to be monitored and balanced on a regular basis. For me, that means blood tests every three to six months, depending on how in-synch my levels are.

I sought out a really good endocrinologist who worked closely with me and showed an interest in my well-being as a patient and as an athlete. During the years that followed, I never felt my thyroid held me back at all. When I moved to the USA in 2001, I needed to once again seek out someone who I could work with and trust.

Over many years I've found this to be a process of discovery and I've managed fairly well to stay on top of problems as they arise; but I do find that at times my levels go crazy. More often than not I find unbalance coincides with stressful times in my life and times when I don't pay attention to my diet and rest needs.

Over the years I've also needed to increase my dosage at certain times when blood tests indicate the need. Right now, I take a particular dosage Monday through Friday, with a slightly lower dosage Saturday and Sunday. In this way, my doctor manipulates my dosage to keep me at the required levels and for now this seems to be working very well.

I'm not a competitive athlete anymore, but I do enjoy regular runs in which I like to test myself. For the most part, I feel I have things under control. I cannot stress enough the importance of finding a good endocrinologist to work with and the need for regular testing to balance your levels. Don't try to manipulate dosages without clear instruction from your doctor. I firmly believe that once I learned this valuable lesson, I could then focus on my sport rather than constantly worrying about how my thyroid was letting me down.

Do you have a specific training or sport related question? Have world-renowned coach Gale Bernhardt answer it! Send your questions to

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Gale Bernhardt was the 2003 USA Triathlon Pan American Games and 2004 USA Triathlon Olympic Coach for both the men's and women's teams. Her first Olympic experience was as a personal cycling coach at the 2000 Sydney Olympic Games.

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