I get a lot of questions about low dose naltrexone (LDN), and while I’ve written about this in the past, I figured I’d put together a quick “5 things to know” post, which includes a few resources for those who are interested in taking LDN. LDN of course isn’t specific for those with thyroid autoimmunity, as it has been shown to help with other autoimmune conditions (i.e. multiple sclerosis), as well as fibromyalgia, complex-regional pain syndrome, and cancer. The good news is that it’s readily available and relatively inexpensive, but as you’ll read, there are some potential downsides as well.
So let’s take a look at the five things people with Graves’ disease and Hashimoto’s should know about LDN:
1. Low dose naltrexone acts on the immune system. LDN, when taken in a daily dose of 0.5 to 4.5 mg, has the ability to modulate the immune system. This could be of benefit to people with different types of autoimmune conditions, including Graves’ disease and Hashimoto’s thyroiditis. Most people with Graves’ disease are told to take antithyroid medication (or receive radioactive iodine), and many people with Hashimoto’s are told to take thyroid hormone replacement. This doesn’t mean that these aren’t necessary, as the reason why antithyroid medication is commonly prescribed is because it is very effective in lowering thyroid hormone levels. And of course many people with Hashimoto’s do need to take thyroid hormone replacement.
When LDN works well it can do wonders, as for those with Hashimoto’s it might allow them to stay off of thyroid hormone replacement (or to take a lower dosage), and for those with Graves’ disease it might allow them to avoid antithyroid medication (or to take a lower dosage). The problem is that LDN isn’t effective in everyone who takes it, which is one reason why it’s not recommended initially. This is especially true with Graves’ disease, as if someone has overt hyperthyroidism most endocrinologists would prefer for their patients to take a medication that has a greater likelihood of lowering thyroid hormone levels, even though antithyroid medication is much more likely to cause side effects than LDN.
2. LDN doesn’t address the cause of Graves’ disease or Hashimoto’s. Most people reading this probably know that LDN doesn’t address the underlying cause of the condition. According to the triad of autoimmunity [1], in order for an autoimmune condition to develop you need the following three factors 1) a genetic predisposition, 2) an environmental trigger, and 3) a leaky gut. Obviously there is nothing you can do to eliminate the genetic predisposition, but you can remove the trigger and heal the gut. When someone takes LDN and it works well it might feel like the person is in remission, and the thyroid panel and thyroid antibodies might even normalize. But in this situation, if someone were to stop taking the LDN then over time their lab markers would probably get out of range again.
Of course this doesn’t mean that you can’t take LDN while at the same time trying to address the cause of the problem. Some wonder how they would be able to tell if the cause has been addressed if they’re taking LDN. For example, if someone with Graves’ disease or Hashimoto’s took LDN and their thyroid antibodies normalized due to the medication, and at the same time they took action to find and remove their triggers, how would they know if the underlying cause was addressed, or if the antibodies were normal solely due to taking LDN? This admittedly could be tricky, and the only real way of knowing is for the person to eventually wean off of the LDN and see if the thyroid antibodies remain normal over time.
3. LDN can negatively affect sleep. Sleep disturbances are one of the more common side effects of LDN. Some people will also experience nightmares. This can be a big problem, as a lot of people already have difficulty falling and/or staying asleep even without taking LDN. Many times this will be resolved by taking LDN during the day (it’s commonly given at night), although this isn’t always the case.
4. Getting a prescription for LDN in the United States isn’t too difficult. For those who choose to take LDN, while it would be great if you have a medical doctor who is willing to prescribe LDN, if not there are other cost-effective options. One option is to visit the website www.ldnscience.org/ [2] and search for a doctor in your area that prescribes LDN. If you live in a different country you might also be able to find a local practitioner who is willing to prescribe LDN. For those who live in the United States who can’t find a local practitioner who will prescribe LDN, you might want to check out the websites ldndirect.com [3] and ldndoctor.com [4], as you can schedule a one-time phone consultation to speak with a practitioner who will prescribe LDN.
5. LDN probably isn’t a good first option for those with Graves’ disease. Since some people don’t do well with antithyroid medication [5], you might wonder why those people with Graves’ disease shouldn’t consider taking LDN initially. Although this is an option, the problem is that LDN doesn’t work on everyone, and if someone has elevated thyroid hormone levels and cardiac symptoms it is important to get the levels under control as soon as possible. If LDN worked as well as antithyroid medication, or even antithyroid herbs such as bugleweed, then without question it would be a good first option to consider.
How about if someone absolutely doesn’t want to be on antithyroid medication, or if they took antithyroid medication and experienced negative side effects? I usually recommend bugleweed for those who can’t or won’t take antithyroid medication, and this is the approach I took when I dealt with Graves’ disease. This is just my approach, and the reason is because I find bugleweed to be more effective in managing the symptoms of hyperthyroidism when compared to LDN. However, if someone is unable to tolerate antithyroid medication and if the bugleweed isn’t effective in managing their symptoms, then LDN should be considered, although there is also cholestyramine [6], which I discussed in a separate article.
Should You Take LDN?
Most of my patients with Graves’ disease and Hashimoto’s don’t take LDN. I can’t say that it’s something I commonly recommend, as many of my Graves’ disease patients take antithyroid agents (i.e. methimazole, bugleweed) while many of my patients with Hashimoto’s take thyroid hormone replacement. But even if they’re not taking anything to manage their symptoms I can’t say that I usually advise my patients to take LDN, and the reason for this is because it’s not addressing the underlying cause, and at times it can make it challenging to know if someone is responding to the natural treatment protocol.
That being said, there are times when I’ll recommend LDN, and if someone is already taking LDN when they begin working with me I won’t tell them to stop taking it. I should also add that I don’t only recommend LDN for the purpose of modulating the immune system in my Graves’ and Hashimoto’s patients, as LDN has other functions as well. For example, sometimes I’ll recommend LDN to those who have small intestinal bacterial overgrowth (SIBO) [7]. The reason for this is because LDN can act as a prokinetic, which can be important if someone has SIBO due to damage to the migrating motor complex of the small intestine.
But getting back to thyroid autoimmunity, and whether you should specifically take LDN, this of course is ultimately your decision. If you have Graves’ disease and experience side effects when taking antithyroid medication, and if bugleweed isn’t effective in managing your symptoms, then perhaps you should consider taking LDN. It might make more sense for those with Hashimoto’s to take LDN since it can prevent further damage to the thyroid gland from occurring while taking a natural treatment approach. Then again, many people have the antibodies for both Graves’ disease and Hashimoto’s, and so an argument can be made that anyone with elevated thyroid peroxidase (TPO) and/or anti-thyroglobulin antibodies should consider taking LDN. But as I have already mentioned, besides LDN not addressing the cause of the problem, it also isn’t always effective in “calming down” the autoimmune response.
What’s Your Experience With Low Dose Naltrexone?
If you have Graves’ disease or Hashimoto’s and have taken LDN, please feel free to share your experience in the comments section below. If you took LDN and it helped please let me know! If you took it and didn’t notice any difference please let me know! If you haven’t yet taken LDN but are thinking about doing so so please let me know!