Low-dose Naltrexone – Hashimoto’s Cure or Powerful Placebo?

 

[HD: This is a shorter-than-usual post – a bite-sized morsel intended to address a recent comment on one of my blog posts about the utility of low-dose naltrexone (LDN) for the treatment of hypothyroidism due to Hashimoto’s thyroiditis.]

One of the commenters on my blog recently left the following comment about her experience with hypothyroidism:

…Coming from a research background I decided to look into things. And there IS a treatment! Low Dose Naltrexone. There is research and evidence that it can lower the immune attack, prevent, and occasionally reverse hypothyoidism. Why didn’t my Endo know about this? Is it because Naltrexone is not sold in the 4.5mg amounts needed, and so not promoted to doctors by pharmaceutical companies?

I am now on it (thanks to a functional Dr) and my chronic fatigue has lifted! I also sleep better at night and have lost weight…

Holy crap, is this true?!  There’s a way to cure Hashimoto’s thyroiditis?  This is amazing!  Unbelievable!  I’m so stoked!  Where can I get this stuff?!  Wait…why have I never heard of this treatment?

Most of you who see “lame”-stream doctors like me have never been offered low-dose naltrexone for your Hashimoto’s thyroiditis because there is no clinical data to support its use in hypothyroidism.  Not limited clinical data.  Not preliminary clinical data.  NO clinical data.  There is not a single study in a peer-reviewed journal demonstrating the clinical efficacy of low-dose naltrexone for the treatment of hypothyroidism due to an autoimmune attack on the thyroid.  If you can prove me wrong, I will print the study and eat the paper.

I realize this is going to come off as me picking on the commenter, which is not my intention.  However, when someone says that she has a background in research and then proceeds to claim that there is evidence to support her assertion that LDN has evidence behind it, I have to challenge her when the evidence is absent.

Let’s do a little experiment.  Go ahead and open up a new tab in your browser.  Go on, now.  I’ll wait.  Got it?  Good.  Search “naltrexone hashimoto’s.”  Scroll down the page.  What do you notice about the composition of the results?  Go 7-10 pages deep into the results.  Notice anything different?  No, you don’t.  It’s all anecdotal “evidence,” mostly from fringe blogs, all citing the same few, historical, miraculous “cures” of other conditions (not thyroid!) that led to the promulgation of LDN as a legitimate therapy for…almost everything.

There is one shining light on page 2 of the results, a well-researched piece by Steven Novella, MD (not ND or PharmD), Low Dose Naltrexone – Bogus or Cutting Edge Science?  Although this post on Science-Based Medicine is from 2010, the concepts hold up well.  And, at least with respect to research on LDN for thyroid dysfunction, not much has changed since then.

Continuing with our experiment, let’s go to one of the most commonly used and respected medical search engines, PubMed.  C’mon, humor me.  Open up the tab.  Good.  Now search “naltrexone and hashimoto’s.”  What do you see?

Zero results?  That can’t be right!  There’s tons of stuff on the Google results!  This must be a conspiracy.  The pharmaceutical companies just don’t want doctors to know about this treatment because then they’d lose money on millions of Synthroid prescriptions!

Right, of course.  The U.S. government (PubMed.gov, people) is in bed with the pharmaceutical companies, conspiring to keep doctors in the dark about this miraculous cure-all.

Moving on, perhaps the original search terms were too restrictive.  Maybe I created a “false positive” just to illustrate a point.  Maybe I’m no more honest than any of the folks out there pushing this treatment.  Well, let’s try a broader search on PubMed, “naltrexone and thyroid.”  That should be a fairer assessment of what kind of data is out there, yes?

Sixteen results.  That’s what you get.  Spoiler alert: none of these papers offers any clinical evidence that LDN can be used to treat, reverse, or otherwise cure hypothyroidism due to Hashimoto’s thyroiditis.

But Google shows 67,300 results for “naltrexone hashimoto’s!”  You can’t tell me there’s nothing to it!  I won’t believe you!  I won’t, I won’t, I won’t, I won’t!

To paraphrase William Shakespeare, “Methinks thou doth protest too much.”  I don’t care how much you want to believe that there is good data supporting a course of action on which you’ve already embarked.  Wanting to believe it’s true does not make it true.

I’m really glad that this issue was raised on my blog, as it is illustrative of a critical concept: Google searches ≠ research, for the most part (Google Scholar notwithstanding).  A web site with “naltrexone” in the title should be viewed with a healthy dose of skepticism, as the bias should be obvious based on the title.  Blog posts written by people detailing their personal experience with LDN do not constitute evidence of its efficacy.  For that matter, blog posts written by clinicians, detailing their “amazing results” using LDN, also do not constitute evidence.

At this point, I’d like to make it clear that I’m not saying LDN can’t possibly have a beneficial effect in people with hypothyroidism due to Hashimoto’s thyroiditis.  What I’m saying is, we don’t know.  To suggest otherwise, no matter how much anecdotal evidence there is on the web, is irresponsible.

But how can you say that all these testimonials don’t constitute evidence?

Easily.  Just as you can offer up blog after blog claiming success with using LDN for hypothyroidism, I can proffer hypotheses as to why it appears to work:

  • There is a powerful placebo effect with any drug that has the type of hype surrounding LDN.  The small community of fringe practitioners promulgating this therapy tends to attract followers who have similar missionary-like zeal.  With all these people extolling the virtues of LDN, do you think you will be more or less likely to believe it’s working?
  • LDN has actually been studied for use in other conditions, where it has shown potential promise.  As it may be useful for fibromyalgia, and the symptoms of fibromyalgia and hypothyroidism overlap significantly, perhaps LDN is treating something other than the hypothyroidism.  In other words, maybe the patient with “uncontrolled hypothyroidism” actually has fibromyalgia (or something else) that responds to LDN.
  • The mechanism of action of LDN is thought to involve chronically increasing endorphin levels through partial blockade of opiate receptors.  Perhaps any positive effects from the drug are due simply to increased endorphin levels, which naturally reduce pain (and possibly improve other symptoms).
  • With respect to weight loss, we already have access to an FDA-approved medication called Contrave, which is a combination of naltrexone and bupropion.  Obviously, there is some utility of naltrexone for weight loss, so we don’t need to invoke a beneficial effect on thyroid function to explain some weight loss (though I should make it clear that naltrexone alone has not been shown to be a powerful weight loss drug).

So what if LDN isn’t making the thyroid any better?  If I feel better on it, isn’t that all that matters?

While I agree that the ultimate goal is to make you feel better, I would simply urge you to consider this: when you use an unstudied thyroid therapy like LDN – despite claims that side effects are minimal to non-existent – you have little idea if there will be any serious short or long-term adverse effects.  In addition, this therapy is said to “boost immune function,” which is a nonscientific, throwaway phrase.  But it does create a contradiction with respect to the myriad conditions LDN is said to improve.  I think Dr. Novella says it best:

Further, there is an inherent contradiction in simultaneously treating diseases that are auto-immune (the immune system attacking the host), and immunodeficiency diseases (like AIDS) and claiming to treat cancer by “boosting” immune activity. Increasing immune activity actually worsens auto-immune diseases, and suppressing the immune system would worsen AIDS. This is a difficult contradiction to resolve.

All I am asking here is for precision when discussing untested and unproven therapies.  If you come to me and say, “I have hypothyroidism, I didn’t feel well, my TSH was normal, and then I started LDN and now I feel better,” I can’t argue with that statement.  I’m glad you feel better.  But let’s not extrapolate your situation to mean that LDN is an appropriate treatment for hypothyroidism or that it can cure Hashimoto’s.

Low-dose naltrexone needs to be studied in the context of a randomized, double-blind, placebo-controlled trial.  I’d be interested in seeing pre-intervention thyroperoxidase antibody levels and post-intervention levels, in addition to the usual thyroid function tests we use to guide thyroid hormone dosing in clinical practice.  Study participants should have low-normal TSH levels at baseline but have reduced quality-of-life (QOL) scores on a standardized questionnaire.  They should have no history of opiate or alcohol-dependence, and they should not be taking any drugs with a central nervous system effect (antidepressants, stimulants, etc.).  They should also be free of other diseases thought to respond to LDN.  If a trial like this shows both benefit and safety of LDN, then consider me intrigued.

One more cautionary tale before I wrap this up.  Selenium, a mineral necessary for proper thyroid hormone metabolism, has been studied in people with Hashimoto’s thyroiditis.  Many in the medical community got very excited when selenium supplementation was shown to lower thyroperoxidase antibody levels – the antibodies that cause thyroid destruction.  We thought that this might be a disease-modifying drug – the holy grail for treating autoimmune hypothyroidism.  Unfortunately, despite lowering antibody levels, selenium was not shown to actually reduce the need for thyroid hormone.  In other words, these patients continued to require the same dose of thyroid hormone as before they started taking selenium.  On top of that, when you look at the trials that have shown decreased antibody levels with selenium use, these trials have been conducted in parts of the world where selenium deficiency is more common (than in the U.S., where it is not common at all).

My point is, there are all kinds of interesting hypotheses out there when it comes to medicine, and many of them sound quite plausible.  Spoiler alert #2: most of these hypotheses will never pan out in real life.  So, be open to new ideas, but be skeptical.  And do not claim that there is research to support an unstudied treatment that you just really, really, really want to believe in.

 

Have you used LDN?  What’s been your experience?  Why do you think it worked/didn’t work?  Are you a physician or other clinician who prescribes LDN?  What kind of results have you seen?  Are you a researcher currently studying LDN?  Comment below!

By interacting with me in the Comments, you agree to abide my Disclaimer.

 

46 Replies to “Low-dose Naltrexone – Hashimoto’s Cure or Powerful Placebo?”

  1. Of course, you understand that the response to your emminently reasoned post will be that, “no one will study this because BigPharma can’t make money off of it”. Obviously you are just another Pharma Shill reaping millions by supressing miracle cures that people know work because they did their “own research”. : )
    I wish your commenter had been more specific about his/her “research background”. This seems as vague as the research itself. I wrote some papers in college. I checked out five books on the subject at the library (pre-internet) and skimmed them for “evidence”. The paper promoted a professor’s pet theory, so I got an ‘A’ for my cherry-picked “proof”. I guess I have a “research background”.

    1. Pharma has been late with their last few payments to my account in the Caymans, so I might just come clean and confess that I am, in fact, a shill.

      In the commenter’s defense, she didn’t know she’d be pushing one of my red-hot hot buttons by being vague about her research. It drives me nuts when people come in to my office toting their research, which consists of printouts from the quackiest of quacky websites.

  2. After being misdiagnosed for 25 years and being told by mainstream doctors that nothing was wrong with me, I finally went to a functional doctor that tested ALL of my numbers and found that I have Hashimoto’s. After 6 months and antibodies in the uncountable range, I decided to give LDN a try. It has been a life-changer for me. After 12 months, my antibodies have dropped to 60, that is not a placebo affect. I have cut my thyroid dose in half and I am thriving like I haven’t experienced in my entire adult life. I am 45 years old and finally know what it’s like to do more than just survive.

    1. Glad to hear you’re feeling so much better, Melissa. Whatever caused the turnaround, LDN or otherwise, we can agree that doctors need to place high value on actually helping people feel their best.

  3. It’s STUPID, by-the-book doctors like you that I, and many Hashimoto’s patients avoid and feel contempt for, and whose opinions I throw into the trash immediately. Your blogs are now getting a lot of disrespect from one of the groups I belong to. Going so far as to say, by someone else, not me, that you should be reported. Good luck with your practice.
    You’re a disgrace to the medical profession.

  4. the plural of anecdote is not data, but we are not always privileged to have a double blind, placebo controlled, adequately powered and properly replicated study. people talk about evidence-based medicine, but i find in my practice [psychopharmacology, with a special interest in bipolar disorder] that i usually run out of strict evidence-based illumination by 15 minutes into the evaluation. there are many issues which i would love to see explored in good studies, but i know it will never happen – they would be too complicated, too expensive, take too many years, require too many patients…. real patients have concurrent illnesses [excluded from the studies], sometimes consume alcohol [excluded], take other medicines [excluded], require 2 [almost always excluded] or even 3 or more relevant agents [always excluded], are not drug naive [usually excluded] and so on.

    nonetheless, i’d like to think my decisions are at least informed by the evidence, even if not directly supported.

    i’ve prescribed naltrexone for many years, as an opiate blocker and an alcohol craving reducer, and for the life of me i don’t see how it could help with hashimoto’s. but stranger things have happened.

    i’d be happy to see an open label case series for a start.

    1. Excellent points, jk – thank you for making them. I really like the way you put this:

      “i’d like to think my decisions are at least informed by the evidence, even if not directly supported.”

      I also agree that an open-label case series for LDN in Hashimoto’s would be a more realistic place to start, as we’re not likely to see anyone get a big enough grant to do a proper randomized trial.

  5. given that naltrexone is pretty benign, especially in near-homeopathic doses, i think it could be offered ethically as an experimental adjunct to standard treatment. on the one hand, it risks having one’s colleagues think you’re a quack, otoh it would add some level c evidence to the level z [=Zero] evidence we have now.

    perhaps it might carry some weight with patients who come in with preconceived notions. i.e. it would allow a treater to say “we tried it on N patients and found they did/did not do any better than our other patients.” but i wouldn’t count on that being persuasive.

    1. You’re probably right, jk, that low-dose naltrexone is benign. At least, it appears to be from what I’ve read on blogs ;).

      You’ve also hit on one of the issues that would prevent me from offering it to my patients until there is some degree of evidence to back it up – it would make me look a quack. In addition to looking like a quack to my colleagues, it would likely attract the type of patient that, under other circumstances, would hate me and my practice style. The doctor-patient relationship would likely go south very quickly, especially if the LDN didn’t work and the patient came in asking for all kinds of other tests and treatments promulgated on quackythyroidblog.com.

      This is actually one of the many reasons why I have a personal “never prescribe desiccated thyroid” policy. Not only do I think it is the wrong treatment, but I also do not want to have my name plastered all over the quacky thyroid forums as the only Endo in the area who will prescribe it. The patients would come out of the woodwork and my days would become real painful, real fast.

      1. “The patients would come out of the woodwork..” Good to know you liken patients to termites that pester you, not humans desperate for treatment that works and a doctor that listens.

        1. I will concede that I used a common expression without considering that it could be interpreted as comparing patients to termites. I offer my apologies for that, as it was not my intention.

          However, in my experience, patients who tend to frequent quacky endocrine forums tend to recommend practitioners who validate their misconceptions. I do not want to be branded as a validator, as it would fill my schedule with people who will not be satisfied with the care they receive from me, so nobody wins.

          1. I’m not here with the intention of only picking out what I don’t like about your comments. I am interested in really talking about this with one of many, many doctors who are so against a relatively harmless treatment, making it difficult to get, while hormone-imbalancing drugs are rampantly prescribed for autoimmune disease. So, thank you for this comment in response to mine. Though, I just have to ask: Why do you think that patients seeking you out for LDN would be any less satisfied than they are now, if they are already out of other options? It seems like denying patients another option that is low-risk flies in the face of the scientific method and the Hippocratic oath.

          2. First, I’m not “against” LDN. I am against the concept of promoting a treatment that has no good quality evidence to support it. If a patient of mine wants to try LDN with their naturopath, fine. I will follow along and chime in as needed.

            Second, I don’t know what you mean by “hormone-imbalancing drugs are rampantly prescribed for autoimmune disease.” If we can restrict the conversation to autoimmune hypothyroidism, then I would not consider levothyroxine a hormone-imbalancing drug.

            Third, I completely disagree that withholding a treatment that has no evidence to back it up “flies in the face of the scientific method and the Hippocratic oath.” Again, if someone seeks out LDN from a willing practitioner, that’s fine. But I don’t want to go down that rabbit hole at this time with that patient (I don’t want to be the prescriber).

          3. I was referring to corticosteroids for a variety of autoimmune disorders, not restricting the conversation to just Hashimoto’s thyroiditis. Although I personally only suffer from Hashimoto’s, I am interested in what is being prescribed for autoimmunity, in general. Some of it, am an learning, can be quite damaging, where LDN is not.

            I guess it’s easy to surmise that you were against LDN, considering that you call prescribing/promoting it quackery.

            Not being a doctor, I can’t obviously speak to what it would be like to be in your position; however, it seems to me that a little more experimentation is in order and is part of a pioneering spirit that we need with chronic disease, since current treatments are not enough to increase quality of life or get to the root of the problem. Just because you don’t want to be part of that, doesn’t mean that others who are willing to experiment should be called quacks, in my opinion.

            It seems as though you seek to discourage discovery, through your rhetoric, which leaves people like me to wonder: is the reality of my disease that I either seek out a snake oil salesman or sit on my ass at home and do nothing because my doctor doesn’t want to try anything other than T4, until such time as someone can get a grant big enough to make a claim substantial enough for doctors to feel safe prescribing more?

            Every single day lost to this disease is too long to us…. And I will be the first to admit that my side of this discussion is fueled by that frustration.

          4. I definitely understand that frustration. One of the points I make throughout my various posts, though, is that it’s often “not your thyroid.” I don’t mean you, specifically, but in general. Hypothyroidism due to Hashimoto’s is fairly common, and the vast majority of people are doing fine. There is a subset of people who are not doing fine because their dose of T4 isn’t optimized or perhaps because they need a touch of T3, or perhaps they are cycling between hypo- and hyperthyroidism (rare). But most people are not doing well because of something totally unrelated to the thyroid, and that’s where it gets tricky, because we can’t say, “You have hypothyroidism, you don’t feel well, therefore you don’t feel well because of hypothyroidism.” That is the lazy approach that many alt med practitioners take, when people come in with stone cold normal thyroid numbers, and say they don’t feel well.

            It often takes a lot of work to figure out what else could be going on (sleep, diet, stress management, other autoimmune conditions, etc). So I object to the cowboys and cowgirls out there who haven’t necessarily done their due diligence, prescribing something that may or may not have value. I am not discouraging discovery; I am discouraging people from burning valuable ATP on something that (in my opinion) is more likely to be snake oil than panacea. Has LDN been tarnished by its association with alt med? You betcha. For me, all it would take is one of the thyroid gurus in the U.S. to run a small but academically rigorous pilot study, show some positive results, and I’d be on board.

          5. It is a possibility that there are other things going on but blood tests have only shown abnormalities with MCV, ALT, thyroid antibodies, and free T3. So I’m considered “fine” (by MDs) with T4 treatment alone, tho my hair is falling out and I have barely enough energy to go to work and have muscle aches most days. T3 supplementation sees me bed-ridden, so that’s out. But, I’m not trying to ask for medical advice, just say that all other avenues (Cytomel and a test for Cushing’s) with multiple endos have been exhausted and now I’m seeing a naturopath who contradicts himself and tries to sell me homeopathic remedies. It’s a joke. But what else is there? That’s why I landed on LDN and asked him for it. He said yes. Seems a bit more supported than mixtures diluted to nothing, so I’ll try it next week. What have I got to lose? Mainstream medicine says I’m fine when I’m not and alternative medicine says I need to take 20 supplements a day. Neither one of those approaches are ok with me. I think by 38, I know when I’m not “fine.” And I eat a healthier diet than literally anyone I know, so I’m not lacking nutrients or eating something I may be sensitive to.

          6. Mainstream medicine says I’m fine when I’m not and alternative medicine says I need to take 20 supplements a day. Neither one of those approaches are ok with me.

            I agree, that is totally frustrating. I am sorry that you’re having such a rough time.

          7. Why isn’t this big research undertaking happening that will satisfy doctors, once and for all, that LDN works (or doesn’t) for a broader range of diseases; and, furthermore, why is the research that is happening not expanded upon, like we see with cancer research?? Is autoimmune disease not a priority in the US? All of the workplace production lost, healthcare costs, and life-savings lost to chronic illness must count for something. Obviously personal comfort of so many people must be pretty low on the priority list for why a proposal gets a grant, so that’s why I mention money lost. Why isn’t this getting more attention? Because I’m sure you can agree that, with so little you have in your arsenal, it’s hard to have some patients come back over and over again with no remission in sight and all labs coming back that point to nothing other than HT…

          8. Excellent question. The answer could fill an entire book. A couple of thoughts:

            – Funding for studies is much harder to get, whether it is from government or private sources.

            – Institutional Review Boards (IRBs) can be obstructionist when it comes to getting research protocols approved, to the point where some researchers just give up. IRBs are supposed to protect patients from harm, which is obviously good, but if they wield their power like Thor’s hammer, it’s a problem.

            – It’s hard to do clinical trials, because the subjects (patients) often have their own agendas and can be unreliable/tough to work with.

            – There probably isn’t much money to be made on LDN, so the funding isn’t there from pharma. If it can be compounded for cheap, then pharma doesn’t have the incentive to fund a trial, as pharma’s version would likely be more expensive.

  6. Given that naltrexone has been used successfully in treating the hyperarousal of post-traumatic stress disorder, I wonder if the success of LDN with some Hashimoto’s patients is simply the result of the overlap between post-traumatic stress and the development of an autoimmune disease. If there really are as many PTSD patients out there as someone like, say, Bessel Van Der Kolk suggests there are (due to the prevalence of child & domestic abuse), it would make sense that clinicians would see them regularly, and that their complaints would not be fully addressed by standard disease treatments.

  7. Finally: a ray of light and a hefty dose of reality in all this hearsay. Just last night I heard of this amazing LDN and wondered why after I had experienced Hashimoto’s for 17 years had I not heard of it. Then I opened up the tab and did the searches and found out why.

    There is no scientific evidence to support this. What I am really amazed by is that the person I spoke with was seeing a ‘qualified doctor’ who advised it was the ‘new treatment’. Me thinks the ‘qualified doctor’ should do a little research too.

    I intend to provide the person I spoke with some information in the hope that they are able to make informed choices about their health and health care. Will also investigate the ‘qualified doctor’ as well.

    Homework is valuable at any age.

    PS. I had my thyroid out earlier this year as it was growing and pushing on my oesophagus to the extent I had difficulty swallowing – no doubt I feel a lot better without it and no LDN to be seen.

  8. In the last para of your post, would it make sense to change “theories” to “hypotheses”? Distinguishing between the two seems important when we are talking about science-related topics.

    1. Fair point. Theory and hypothesis are not synonymous, though I was using them that way. After rigorous testing of a hypothesis, it may then be classified as a theory if it seems to be holding up against scrutiny.

  9. I understand your point here, but let’s just be realistic.
    I waited ten years for a doctor to take me serious about my thyroid. I told the doctors that I was constantly tired, couldn’t make sound decisions, was basically losing my mind, etc.
    At the same time, I developed interstitial cystitis. I went to the doctor who tested my urine for white blood cells and sent it off to the lab. White blood cells, no bacteria. Hmm. Antibiotic. Which made it worse. 6 months of life interruption because I was in so much pain I could not stand. I researched and pointed out that I thought I had IC.
    Finally, a urologist took me serious. Gave me an ultrasound. I had IC.
    Same doctor tested my antibodies. They were crazy high. Oh. You have hashish.
    Finally. Help.
    I waited, in serious suffering for a long, long time for someone to take me seriously. And, because I moved around for college, fought the same freaking battle to be on something more than Levi.
    By the time someone FINALLY listened to me, I had zero cholesterol. Zero. Like, the autoimmune issues were so bad that I had zero cholesterol and could not function on Levo alone.

    I understand you don’t want to look like a quack, but the people on the internet are desperate for something that works. Something to put their lives back together after being absolutely miserable and often unable to function.

    You took an oath to help people, not to do what was in YOUR best interests.

    Now, that might not be prescribing LDN, but if it’s not, and you aren’t listening to the misery your patients are facing and arent willing to at least TRY something that might help them and has very few negative effects, then why are you even a doctor.

    What your post ignores is the very serious suffering that some of us have faced, the dismissal from doctors when we complain and beg for suggestions.

    I was told repeatedly that I was just depressed, when I was actually very, very very sick.

    So if you aren’t willing to prescribe LDN, fine. But it’s posts like this that are really infuriating because you aren’t just protecting your reputation, you’re also failing to acknowledge the pain and suffering of people with families and lives.

    So, even if you’re not in the sheets with big pharma, you are being unethical: your job is to serve and keep/help people to be healthy, not to worry about your reputation.

    1. I am sometimes willing to offer my patients a treatment that I don’t think will work (see T3 Or Not T3 – Exploring The Controversy), but my ethics dictate that I have to draw a line somewhere. Is it ethical to offer intraperitoneal yogurt infusions if that starts being touted as the treatment du jour on the quacky thyroid blogs? Not in my opinion.

      As doctors, we do want to help our patients. We do recognize that the people in our office are suffering. But the binary choice you offered (give an unproven treatment vs abandon our ethical duty) is a false dichotomy. If you want that kind of care, you can get it from a naturopath. And when you are finished spelunking down rabbit holes with someone who is not qualified to practice medicine, then we can talk.

        1. I do understand her point. Maybe talking will help us pursue other avenues and maybe it won’t. But I’m not prescribing something without evidence to back it up just because nothing else seems to be working. Sometimes we just can’t figure out an answer, so it may be time for the patient to move on to another provider if I’m unhelpful.

          1. Why are other MDs prescribing it, then? I don’t deny that they sometimes have to be begged, but this is catching on. More than just with NDs. The amount of stories of remission and relief on LDN can’t all be placebo effect, and the risks are so low…
            https://www.ldnscience.org

          2. I know of zero MD’s in my area prescribing this stuff. Once you start researching LDN, Christina, you have to realize that you are in the echo chamber, so to speak. You will be reading about a tiny fraction of the medical community, promoting their ideas with great zeal. I see how one could get the impression that it is “catching on,” but I assure you it is not. It is only catching on on blogs/sites that are dedicated to it.

            And yes, this “improvement” actually can be 100% due to placebo effect. Just look at the forums that promote taking hydrochloric acid for heartburn. There are a whole lot of people who swear by it, but there is not a shred of evidence that it would be helpful.

          3. That is an interesting perspective. It seemed to be catching on in mainstream medicine only where I was reading about it, true, due to multiple anecdotes about “talking” this MD and that MD “into finally prescribing it.” Do MDs really always know if another is prescribing it, but just not admitting it to their colleagues?

          4. I suspect that MDs in my area are not prescribing it, as my medical assistant takes a thorough medication history from every patient, so I would see more people on LDN if it was being prescribed.

  10. I think we can agree that dampening the autoimmune response will greatly benefit Hashimoto’s patients. So, let’s broaden our search a little, shall we? Not asking you to eat paper, but even at merely bachelor’s degree level, I know to branch out in a search for relevant information. Try searching for “low dose naltrexone autoimmune” and you find quite a bit of published research.
    https://www.ncbi.nlm.nih.gov/m/pubmed/?term=low+dose+naltrexone+autoimmune

    1. Yes, I am aware of the research on LDN and other autoimmune diseases. But I will reiterate, there is no evidence it is helpful in Hashimoto’s. If it does dampen the autoimmune attack on the thyroid, which it might (no evidence!), then that of course could be helpful.

      1. So, forgive my ignorance, but isn’t dampening the autoimmune response at all beneficial when talking about any autoimmune disorder? Including Hashimoto’s?

        1. The answer is: maybe. Take selenium for example (I’ve written a two-part post about selenium; part 1 goes into detail about selenium for hashimoto’s). Selenium seems to lower TPO antibodies, yet it doesn’t necessarily seem to have a major, clinically meaningful effect. However, if LDN truly dampens the autoimmune attack on the thyroid, then yes, it has the potential to be beneficial. It doesn’t mean that it is definitely beneficial, but it certainly could be.

  11. I was one of those Hashimotos patients that had gone undetected long enough to go into Thyroid Storm with a TSH of 93, off the charts undetectable T’s, and both thyroid antibodies between 6,500-9,000. Nothing helped get my antibodies down, even when controlling my TSH and T4/T3. After over a year of my antibodies hanging tough in scary-high thousands I decided to try LDN. Within 3 months of taking it at 1.5 nothing happened. After 3 months my dose was raised to 3mg. Within a month of taking the higher dose my antibodies BOTH came down to 2,200. Some people are scared by THOSE numbers. It makes me over the moon happy. I am going to increase to 4.5 in a few weeks. I am hoping that dose will bring them down to zero. Because of my situation I have decided to return to school and I am applying for medical school in the spring. I will be the one that does the research on LDN. Good or bad. This needs to be done. I do not believe that this could have been a mistake. I actually did not believe that it would work, which I think is a requirement of a placebo. I am overjoyed that it did in fact work for me. It did not decrease my need for thyroid meds. I do not care if that ever happens. I just want to stop the immune attack itself. I hope this has been helpful. I will return to this post in a few years with my results.

    1. Just a few points of clarification for those reading Lee’s comment:

      – A TSH of 93 represents significant hypothyroidism. Thyroid storm is severe hyperthyroidism which can be acutely life threatening.

      – The important part of treatment for hypothyroidism/hashimoto’s is making sure the person feels well. Lee doesn’t say whether there were residual hypothyroid symptoms, or just that there were antibodies present. Antibodies themselves, as far as we know, do not have effects on the body other than what they do to the thyroid function.

      – If antibodies decrease and thyroid hormone requirement stays the same, then I’m not really sure what the point of that is other than to lower a number on a page. But, if it makes someone feel better, in any respect, then it’s ok as long as no harm is done.

  12. I found a study for you… 🙂

    Alteration of prescription-only drug utilization by low dose naltrexone users with hypothyroidism. A cohort study based on the Norwegian prescription database from 2011-2015

    Kim Phung Khong (Master student)Email the author Kim Phung Khong, Lars Småbrekke, PhDEmail the author PhD Lars Småbrekke, Guttorm Raknes, PhDEmail the author PhD Guttorm Raknes
    DOI: http://dx.doi.org/10.1016/j.sapharm.2017.02.084

    1. Unfortunately, it looks like the only thing they published is an abstract. No manuscript has been published. The study does not seem to have looked at levothyroxine; they examined whether other medication doses changed. So not sure this study, even if published, will help answer any questions about hypothyroidism.

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