• Exercise modulates thyroid hormone levels, deiodinase expression, and receptor sensitivity, exerting dynamic multi-organ regulation.
• Exercise interventions can reverse pathological phenotypes in liver, bone, muscle, heart, and brain associated with thyroid dysfunction.
• The review synthesizes evidence from 81 studies, highlighting both molecular mechanisms and organ-specific effects.
• Current evidence is largely from rodent models and aerobic exercise; clinical validation in humans is needed.