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.


104 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.

      1. I have primary progressive multiple sclerosis. I am 65 years old. I have been on all MS therapies I couldn’t tolerate for 16 years. I was made aware of LDN and was prescribed 4.5 mg. Nightly. It certainly has improved my quality of life. I will probably have to stop it. My condition has worsened and I will be going on Ocrevis to try and slow further progression of MS. LDN simply put was great for improving quality of lifr, but does nothing to stop your immunr system from attacking itself. Hope that helps. 😃

          1. As far as I can tell, there is no data in there about treating thyroid problems with LDN, which is the only use for LDN relevant to this post.

    1. Yeah…I’m still waiting for my favorite cardiothoracic surgeon to complete his Endocrinology fellowship.

  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.

      1. LDN or otherwise? Wow HD.. LDN has been demonstrated to help rebalance the immune system (the effect is immunomodulatory not just giving some pain relief). You are very aggressive in all of your stances on this site.

        It would be nice to see you trying to learn more from the literature and broaden your understanding of immunology rather than making sweeping statements while pointedly ignoring parts of the discussion (eg the immunomodulatory nature of LDN therapy).

        I think the reason many people find “traditional” doctors difficult to deal with is that they have this type of attitude where they “know all the answers” despite medicine being a constantly evolving field.

        I apologise that this response is a bit general – I’ve been reading a number of your articles (and comments and responses) and as a postdoc in medical research I find your “absolute truths” approach a bit galling.

    2. I have the same experience -I was on thyroid replacement for many years with antibodies in the uncountable range. The range dropped dramatically down to around your figure with the start of LDN. I was surprised and pleased. I now have more energy.

    3. I’ve just started LDN for Hashimotos also. I asked the dr how we’d know it’s working and that’s exactly what he said, my lab work would improve. That’s not placebo effect on how I “feel”, that is medical documentation. The lab results are what prompted the doctors to raise or lower my levothyroxine for the past 20+ year (diagnosed age 20, and son was only 10 when he was diagnosed. It runs, gallops thru our family 3 generations back on both mother and father’s side). It cannot be both ways levothyroxine works and the proof is in the lab results but ldn is just placebo lowering lab work. It is a measurable effect! Thank you for sharing your experience! My son and I are hoping we can help our thyroid and other autoimmune issues going on. Here’s hopin!

    4. I have been on LDN for 3 months and I feel fantastic . No more waking up like I am 85 years old (I am 40) the pain getting up was so terrible in the morning I used to have to shuffle . I have Hashimotos. I just looked at a video my friend sent to me today of her and I at lunch and even she said my face looked “normal” in other words no more puffiness. So is it miracle ? Idk 😐 but combined with a clean organic low carb diet it is working for me !!!! I have only lost 7 lbs though but the puffiness in my face is mostly gone. So… you tell me…

  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.

    1. I beg to differ with you, Linda. This post has been expressing exactly what I’ve been thinking. Led blindly by my doctor into taking LDN has left me with more doubts than convictions. My TPO antibodies were finally low for three consistent years, almost within normal limits (between 30 and 40 for 3 years). I started LDN and within 6 months, my antibodies began to increase again. Now, they are 150. I have searched and searched to find actual clinical trials regarding hashimoto’s and LDN, as I’m beginning to be concerned that it may have some opposite effect in some individuals, myself included. I’m so glad that someone else FINALLY voiced my confusion as to why LDN is being recommended, mostly by anecdotal evidence, when there is no clinical research regarding how it works. As happy as it makes me to hear that others are well on it, my own concerns have been flooded out by the endless blogs citing the same couple of “studies” which aren’t actually studies at all and never include Hashimoto’s patients.

      1. Additionally, scientific hypotheses (the kind you find in research) function by being repeatedly tested. To silence someone who is simply calling for more evidence, i.e., “testing” a hypothesis that has not yet been researched beyond individuals who have personal success, is not a great way to further the popularity of your own hypothesis. If you think it works because it helps you, I’m glad. But many others may be questioning if it is so. They have just as much right to call for more research as you do to sing LDN’s praises.

        1. So eloquently stated, Sarah. This also brings to mind a saying I’ve seen on many skeptic web sites: “The plural of anecdote does not = data.”

  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. Talk about what? The few choices already explored that aren’t working? You don’t get the point she is making.

        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…

          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.

    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.

      1. The point of taking a substance that might lessen the autoimmune attack is clearly to reduce further damage to the patient’s thyroid gland. It’s curious that you are dismissive of the value of reducing autoimmune activity: what about 20 YEARS of thyroid symptoms, positive antibodies for both Hashimoto’s and Graves, sometimes abnormal TSH, but always and still too subclinical for any type of thyroid medication? I hope you can understand that your comment ” 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.” sounds ludicrous and says a lot about your point of view and very little about how we might be able to help people. It lacks critical thinking, badly. This LDN page is the only page of yours that I’ve read and it’s easy to assume that you don’t do research. Though, I am sympathetic to your distress over the promotion of unproven treatments. We should do the research.

        From what I’ve been told, the only use of antibodies is to Dx the autoimmune condition. Antibodies fluctuate without LDN and science doesn’t know why. So the “lowers antibodies” theory shouldn’t be used, or should be tracked and published.

        In one of your other comments, you complain that LDN cannot be both an immune suppressant for autoimmune disease and a substance that strengthens the immune system to fight of cancer. If your read the advocacy websites, they say that LDN is supposed to “balance” the immune system, not suppress nor strengthen it. Since people are taking regular dose 50 – 100 mg of Naltrexone, I believe it is very likely that we would know if Naltrexone was significantly suppressing or strengthening immune systems. There would be warnings about it, because patients taking the regular dose would have adverse outcomes. If LDN suppresses or enhances the immune system at 0.5 mg – 10 mg amounts, presumably patients taking the regular 50 mg – 100 mg dose would have a noticeable immune response and it would be documented.

        Unfortunately, I am not convinced that your point of view is anything more than that of a mainstream Dr who does only what he was trained to do in med school, which includes being tone deaf to options that might help some patients. You do your well, but it leaves some people hanging. I guess it’s just not your problem, not your battle to fight. The fact that you have the audacity to blog about it – doesn’t impress me.

        1. The point of taking a substance that might lessen the autoimmune attack is clearly to reduce further damage to the patient’s thyroid gland. It’s curious that you are dismissive of the value of reducing autoimmune activity

          I would love to be able to decrease the autoimmune attack on the thyroid; my point is that I’m not sure if LDN really does that in a way that is clinically meaningful.

          …you complain that LDN cannot be both an immune suppressant for autoimmune disease and a substance that strengthens the immune system to fight of cancer. If your read the advocacy websites, they say that LDN is supposed to “balance” the immune system, not suppress nor strengthen it.

          The advocacy websites are a terrible source of information, no offense intended. Ask any doctor or scientist what it means to “balance the immune system,” and they will stare at you blankly. Nobody knows what that means or how to do it.

          The fact that you have the audacity to blog about it – doesn’t impress me.

          Again, calling for more scrutiny of an Alt Med-promoted therapy that has zero evidence is hardly audacious.

  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.

  13. Oh man I thought I was on to something. I have Graves’ disease I mostly feel okay, besides occasional fatigue and insomnia just really want to lose weight I gained 30 pounds (150 pounds currently) in the last year before that I was in remission (weighed about 120 at 5ft 4) for about 8 months felt great.

    Anyway was just wondering if it would be worth it to at least try LDN with the antidepressant to help me lose weight. Also I wonder if I’m one of those people that go between hypo and hyper randomly. My current doc is kind of an idiot and I’m pretty sure only deals with diabetics and knows jackcrap about thyroid disorders.

    Also people are too sensitive these days lol yes we all have problems but we need to be realistic not butthurt

  14. October 23. 2017 Levothyroxine 150 mcg
    March 9, 2018 137 mcg
    July 18, 2017 125 mcg

    I will be seeing Dr next week, and may end up with even lower dose Levo.

    Started LDN 3.0 in October 2017
    Thyroid Peroxidase Antibody
    714.4 IUnits/mL
    Date: Oct 19, 2017 07:04 a.m. EDT
    395.9 IUnits/mL
    Date: Oct 22, 2018 07:15 a.m. EDT

  15. I saw my medical doctor today, and am being prescribed LDN to see if it can help in my treatment for Hashimotos. She routinely uses it in her treatment plan. So, maybe things are changing, and soon you won’t be considered a “quack” by offering it as something that might improve a person’s quality of life.

  16. As you stated, there are no studies to support LDN however I didn’t note studies that confirmed it did not. When my father was diagnosed with RA, he was in a study @ The University of CT. Methotrexate was the “snake oil” at the time. Thank God his Dr was not so closed minded. Did it cure him? No. But it did stop the progression of the disease. He was able to live more comfortably. I think there should be studies done on this before passing judgment. Naltrexone has been helpful for drug addiction. Is a lower dose helpful for other diseases? I don’t know, however, why wouldn’t it be looked into? I have Hashimoto’s & it sucks. Most Dr tell me it is all in my head. Of course I have symptoms like hair loss, eyebrows fading, unexplained weight gain. But it is all In my head. I suffer with diarrhea however, my local hospital & several physician’s advised I must be doing this to myself. And you wonder why folks seek out alternative medicine? I guess if it is something easy like birth control they can handle it but if it isn’t good luck.

    1. Fellow Hashi, here. I haven’t been taken seriously by a doctor until very recently. I finally have a functional medicine doc that isn’t an ND quack. Up until now, the hairloss “will go away.” It hasn’t stopped for 7 years now. The muscle aches, headaches, and fatigue “should be controlled by the right levels of T4 and T3,” right? Nope. Try again. Hypoglycemia, constipation, anxiety… Something is wrong here when I’m on the right doseage of thyroid hormones and I’m still very symptomatic. This doctor (DO) is actually looking into my symptoms. It’s amazing. With an anti-inflammatory diet, the right kind of exercise, and acupuncture, I’m seeing results. Too many doctors don’t take the time to explain this. Sadly, LDN didn’t make much of a difference in my antibodies after one whole year on it, taken religiously. But that doesn’t mean it won’t work for you. Keep trying!

      1. I’d like to highlight the point that, if “thyroid” symptoms are not controlled on what appears to be adequate doses of thyroid hormone(s), doing a deep dive into diet and exercise may yield great benefit.

        1. I did just that. I did the 21 Day Elimination Diet. I don’t eat gluten & minimized dairy. I took up running. I don’t smoke or drink. I keep a regular sleep pattern. Finally after completing everything I could do, I decided it was time to get help. I began Naturethroid 6 months ago. My numbers are better & I do feel a bit better.

  17. Have you ever tried to used medical cannabis? I read that Medical marijuana is a very old medicinal herb that has been used for thousands of years to treat a great variety of ailments. Cannabinoids, have been shown to have anti-bacterial, anti-cancer, anti-inflammatory and anxiety reducing properties that have helped a great deal in several illnesses. Although research has not found medical marijuana to fully treat thyroiditis, it has been found to treat the underlying symptoms associated with the illness. Research studies have found that THC reduces inflammatory responses in people with autoimmune disorders and in this case thyroiditis. Nowadays, there are several products of cannabis created, not only for smoking. Like this one http://www.ilovegrowingmarijuana.com/durga-mata/. If you have any questions or opinions please let me know. Thanks!

    1. I am not familiar with literature for cannabis as it relates to thyroid dysfunction. If you have any papers to cite, I’m interested. I do have many patients who use it for a variety of conditions and find it helpful, but I have no experience using nor prescribing it.

      1. Do you discourage the use of this unsupported medical substance? Do you believe it helps your patients or do you advise them it is nothing but quackery?

        1. I haven’t seen it “help” anybody, but I also haven’t seen enough people already on it to really know. I tell people exactly what I’ve written here: there is zero evidence for its use. If they want to stay on it through their alt med provider, that is their prerogative. But I tell them I’d recommend just stopping it.

  18. HD- You are a complete idiot- Numerous studies have been done showing that LDN lowers antibodies in Hashimotos patients along with lowering inflammation. That alone is why LDN is beneficial in Hashimotos- If you don’t agree that lowering antibodies in people with Hashimotos is beneficial than you’re clueless. Is it going to work for every single person that tries LDN- No. But what drug works for Every Single Person that tries it? You come off like a pompous ass that just wants to argue. If your point is you want more studies than fine- I’m sure they’re coming- I feel sorry for any patients you treat

    1. Sorry Dan, but there are zero studies showing that LDN lowers thyroid antibodies. You are welcome to prove me wrong by citing a reference to a journal article that proves you correct.

      Also, not interested in arguing. Just interested in science.

      1. I am a live study. Long story short…I’ve been on thyroid meds for about 15 years. Started taking LDN along with my Bupropion because it was cheaper that way instead of Contrave for weight loss. I had no idea it helped thyroid. Well anyway, I no longer take levoxyl and Nature throid for Hashimoto. In fact I went from hypo to hyper so I had to stop thyroid meds to level it out. Pain is so much better. I feel great most days now. Where as I was in be a few times a week in pain and feeling like death. I haven’t lost weight yet tho.

  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298009/

    For what it’s worth. No results about efficacy or safety, just that it’s plausible to infer that *maybe* LDN can provide some benefit to people who have been prescribed it based on the meta analysis of persistent purchase numbers (patients who purchased a second prescription, third, etc).

    Seems like it’s just worth pursuing the research, but unfortunately it seems like research in the US is typically funded by companies who can profit, not research grants.

  20. This is the proper way to think about medicine, if there are no studies you shouldn’t be prescribing it……me and the other civil war surgeons are still waiting for peer reviewed studies on this whole “washing your hands and instruments” quackery as well. The studies say that the survival rate of any surgery is about 50%…..that’s just the way it is. I have approximately nine family members with hypothyroidism including myself, never once heard any of them say levothyroxin improved their life in any way…..(that was an example of anecdotal information). You keep doing things the way you were taught, we wouldn’t want you making people feel better… if it means your peers will think you are a quack.

  21. Your article here sounds kind of dismissive, and I understand that without well-performed research, we can’t say anything for certain. Definitely. Nevertheless, in deference to the many Hashi’s patients who have experienced a better life on LDN, your tone might be a bit more tentative and polite, saying only that “we can’t know anything for certain, but there are many who claim to be helped, although we can’t possibly know whether this is placebo effect or actual help”. (I can attest, though, that in addition to no flareups whatsoever of my Hashi’s in terms of symptoms, my tested antibodies have tumbled to “0” on the LDN with nothing else done to try to achieve this.)

    At any rate, your column was written in 2017. In 2018, this appeared on PubMed:

    “Within a specific dosage window, LDN can act as an immunomodulator in multiple autoimmune diseases and malignant tumors as well as alleviate the symptoms of some mental disorders.”
    ~ https://www.ncbi.nlm.nih.gov/pubmed/29885638

    The abstract didn’t specifically name Hashi’s, but nor does it stand to reason to assume Hashi’s cannot be helped if other AI disorders can be helped by it. So we at least have this, and it’s a beginning. Regrettably, the full report is paywalled and I have no access to it to learn what AI conditions they were referring to.

    1. Hopefully, someone reading this will already have a subscription to that publication, or be willing to get past the paywall, to relay the findings of that study?

    2. I would say my post is more critical than dismissive. I’d point you to this paragraph in particular:

      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.

      Since the article you link to is more of a review than a study, I suspect it will not break any new ground with respect to LDN and the thyroid (though I have not read it).

      Quick update: I skimmed the article and I don’t see anything about the thyroid.

  22. My daughter has been suffering with thyroid disease for some years, and symptoms have worsened in the past year. Ive been checking out any and all posts, and came upon this site after seeing something about low dose Naltrexone. As a traditionally trained health care provider, but not in endocrinology, I thought it sounded pretty weird, and wanted data to support its use. Read all the posts on this site, and decided to track down the research article listed by Cherwin A above. ( “Low-dose naltrexone (LDN): A promising treatment in immune-related diseases and cancer therapy.” Int Immunopharmacol. 2018 Aug )
    I found it . You can cut and paste this in your search engine and access a PDF.
    –> https://www.immunetherapeutics.com/wp-content/uploads/2018/08/Low-dose-naltrexone-LDN-A-promising-treatment-in-immune-related-diseases-and-cancer-therapy.pdf?fbclid=IwAR3wNH0hML_60SHTrXgDWXK8oQcnQLsVsu5Hlv3QjROudtRN2-tegsTXNhw

  23. Research on off label uses has been expanding, and includes studies on overall safety of the medication, and on several autoimmune conditions, including RA, IBS and some others.
    Below are some of the recently published studies. The safety study is at the bottom
    ( It is safe, and no serious adverse events were noted in 11,194 patients )
    Perhaps in the not too distant future Hashi’s will be included in a study as well.

    Having reviewed a number of these studies now, I can’t say whether or not I’ll suggest my daughter look into trying this. I’m more inclined to have her try the Anti Inflammatory Diet ( an elimination diet ) This program begins with eliminating MOST foods, and gradually re-introduces food types while monitoring and documenting any adverse reactions. A similar method determined the cause of Celiac disease.
    While it sounds incredibly arduous, it might be worth the effort if it improves her profound fatigue, chronic coldness, paresthesias and anxiety, none of which have resolved with levothyroxin and the addition of cytomel. Her recent endo told her that her recent ultrasound showed her thyroid “looking like a cauliflower” despite a negative antibody test. It is indeed crazy making- not only for her, but also for her husband and kids. Truly, simply replacing T4, and T3 if indicated is not necessarily sufficient for every thyroid patient. It is a much more complex problem than diabetes- and that can be pretty tough!

    Anyway, sorry to go on and on. (you can perhaps see that it’s driving me crazy too)
    The studies are listed below if anyone has interest. Let’s hope that some controlled studies can be done with Hashimoto’s misery.
    -sue s.
    Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization
    Med Sci (Basel). 2018 Dec; 6(4): 82.
    Published online 2018 Sep 21. doi: 10.3390/medsci6040082
    “In general, all of the low-dose features regarding naltrexone and naloxone have been only recently and still scarcely scientifically evaluated. This review aims to present an overview of the current knowledge on these topics and summarize the key findings published in peer-review sources. The existing potential of LDN, VLDN, and ULDN for various areas of biomedicine has still not been thoroughly and comprehensively addressed.
    Journal Crohns Colitis. 2018 May 25;12(6):677-686. doi: 10.1093/ecco-jcc/jjy008.
    The Effect of Low-Dose Naltrexone on Medication in Inflammatory Bowel Disease: A Quasi Experimental Before-and-After Prescription Database Study.
    Conclusions : Our findings imply that the initiation of LDN in IBD is followed by reduced dispensing of several drugs considered essential in the treatment of CD and UC.
    Low dose naltrexone: Effects on medication in rheumatoid and seropositive arthritis.
    A nationwide register-based controlled quasi-experimental before-after study
    PLoS One. 2019; 14(2): e0212460
    In recent years, low dose naltrexone (LDN) has been used as an off-label therapy for several chronic diseases. Results from small laboratory and clinical studies indicate some beneficial effects of LDN in autoimmune diseases, but clinical research on LDN in rheumatic disease is limited
    Published online 2019 Feb 14. doi: 10.1371/journal.pone.0212460
    BMC Med. 2019; 17: 10.
    Published online 2019 Jan 15. doi: 10.1186/s12916-018-1242-0
    randomised controlled trials of oral naltrexone: a systematic review and meta-analysis of the safety of oral Naltrexone
    Results : Eighty-nine randomised controlled trials with 11,194 participants were found, studying alcohol use disorders (n = 38), various psychiatric disorders (n = 13), impulse control disorders (n = 9), other addictions including smoking (n = 18), obesity or eating disorders (n = 6), Crohn’s disease (n = 2), fibromyalgia (n = 1) and cancers (n = 2). Twenty-six studies (4,960 participants) recorded serious adverse events occurring by arm of study. There was no evidence of increased risk of serious adverse events for naltrexone compared to placebo (risk ratio 0.84, 95% confidence interval 0.66–1.06). Sensitivity analyses pooling risk differences supported this conclusion (risk difference −0.01, 95% confidence interval −0.02–0.00) and subgroup analyses showed that results were consistent across different doses and disease groups. Secondary analysis revealed only six marginally significant adverse events for naltrexone compared to placebo, which were of mild severity.
    Conclusions: Naltrexone does not appear to increase the risk of serious adverse events over placebo. These findings confirm the safety of oral naltrexone when used in licensed indications and encourage investments to undertake efficacy studies in unlicensed indications.
    –> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332608/

  24. I can’t see scientific logic, that you claim to have, regarding your comments on Selenium. You claim that Selenium effectively progress, but did not reverse, Hashimoto’s, and you seem to be disparaging about that. It would seem that it may have stopped some progress = good.., but failed to restore cells that have been auto-immunologically damaged/ no longer viable – no suprise. That would possibly be the role of stem cell therapy, or a religious miracle, and halting progression of disease cellular damage would seem beneficial. It is a simple A+B=C, for that part. Why did you not allow that obvious connection? Scientifically inept, or extreme bias?

  25. I found this post interesting and informative. I love PubMed and I found nothing about LDN on it either.

    That being said, I have been taking LDN for about eight months now. After a mesh hernia repair and birth of my second child I began to feel unwell. Four years later my doctor discovered I have developed hypothyroidism and also Hashimoto’s. She told me about a drug that has shown to help patients with other autoimmune diseases and asked me if I would like to give it a try. I couldn’t find any published studies, but desperate to feel “me” again I called her office and agreed. I feel night and day difference and have been able to lower my dosage of Naturethroid from 1.5 grains to just a half grain.

    I’ve often wondered if it’s treating something else (like you mentioned), or my brain has taken control (placebo), and if I’ll regret my decision to take this drug later in life… but I can’t deny how much better I feel for now.

    I stumbled on this because I was searching for results from others’ regarding swallowing LDN and whether or not anyone else has trouble doing so. My first batch was compounded in burgundy and white capsules and I had no issues, but my current batch is in hot pink capsules and it’s as if they sit at the top of my throat. I’m assuming it’s a change in fillers? If anyone has insight feel free to respond!

  26. I am a chronically I’ll person (with Hashimoto’s as well as another condition) that lost a decade of my life due to the difficulty of first diagnosing and them finding treatments, since the conventional treatments have done nothing for me. With respect, I just don’t think you have any clue about the desperation that comes with fighting a chronic illness day in and day out.

    I was willing to try anything that wasn’t dangerous to treat my illnesses. I’ve tried a LOT of experimental things. Supplements, medications, sleep regimens, weird gagets, breathing exercises and meditation, diets, and more. I did so *knowing that most would be ineffective or even downright snake oil,* because as far as I could tell, that was what it was going to take to get lucky and stumble on the right thing.

    And I was right. Of the dozens of things I’ve tried, only two really made an appreciable difference. But those two made ALL the difference, as I now have my life back and can once again live and thrive, instead of merely surviving each day. I can say with 100% certainty that had I stuck with evidence-based medicine in the sense that you mean it, I would still be just as sick as ever. I wouldn’t be working, I would be miserable, and frankly I might have been a suicide risk by now. (Yes, I tried antidepressants and they never did a thing for me). The snake oil was worth every last penny and every last minute of my life that I spent on it, to find the treatments that work.

  27. Keep in mind the reason people are more than willing to try something like LDN to help them, without all the bought and paid for studies, is BECAUSE of doctors being in bed with big pharma. MOST doctors, not all, but most, are simply legalized drug dealers. And the public is sick of it. It took me 22 years and seeing literally over 20 doctors until ONE, one doctor decided to check my thyroid properly. The rest of them, the highly trained “geniuses” you all like to claim to be (Just how big are those tables that you wheel your heads around on?) all just read the basic blood work, said “You’re in range, you’re fine” and that was it.

    You might be the finest doc in the world, I don’t know. But when the majority don’t care about anyone’s nutrition, or food allergies/sensitivities, and just want to whip out the script pad you can see why people don’t really care about your precious drug studies. We, are sick of YOU.

  28. Diagnosed w recurring/remitting MS 22 years ago, Hashimoto’s just a year ago, and menopausal for the last 3. I’ve struggled, I’ve fought, all without drugs.
    I watch everything I eat, I exercise often, and truly done EVERYTHING I can to manage my immune system and keep the process at bay. Started seeing an integrative specialist when I became diagnosed with type 2 diabetes which came up when I hit menopause. I am not overweight at 138lbs and 5,5″ and a body builder for 15 years now. Genetics are a bummer sometimes.
    She gave me Metformin, raised my Vit D, and started me on LDN. Been on LDN for 8 months now. Within 3, my numbers were negligible and was feeling wonderful. So great, in fact, that I forgot to reorder it and the pharmacy closed. Long story short, I had to have the dr contact another compounding pharmacy. All told, a 3.5 week process! I felt like I was dying! ALL my symptoms came rushing back, my numbers jumped back up, my life as I knew it was gone, yet again. Fast forward 2 months and I am finally living again. My hair is growing in after a major fall, my exhaustion has been remedied, the veil of fog has been lifted from my brain and I, ME, all of ME, is back!! I’m looking forward to seeing my numbers nice and low again. When you are ill, have tried literally everything, and life is hard, you become willing to try anything. If this is snake oil, that’s ok! I’m in!! Rather than spend your time looking for clinical trials…maybe kill off some of your amazing brain cells on finding a way to see if theres something to it by compiling the statistical data of people like us and making those trial happen. This is a real miracle for those who suffer. While I pray it will not cause further detriment, I absolutely KNOW it has made a positive difference. And I’m so grateful to have found an open minded, well read, Dr. who has been able to make a significant change in my existence!! Wishing health and happiness to all👍

    1. It’s fantastic that you’re feeling so much better – very glad to hear it. I certainly understand the willingness to try anything when nothing has worked.

      1. With respect it seems like you have no clue what suffering is! No clue the toll an autoimmune disorder takes daily on a person. Wait….my bad! Your a doctor…you know everything. I almost forgot

  29. I love your sense of humor. This article cracked me up!

    I took LDN a few years ago. It wiped out 15 years of pain and inflammation caused by Ehlers-Danlos Syndrome. I had been put on *a lot* of drugs that did nothing, so I knew it wasn’t placebo.

    Seems like LDN could potentially help modulate the immune system through T-cells, lowering the inflammatory aspect of Hashimoto’s. (Forgive me if I butchered that. I’m not a doctor). I don’t see how it would affect the endocrine problems themselves, though. Seems like that’s between you and your patient–to decide if it could lower the inflammation, which could help with some of the painful symptoms of Hashimoto’s.

    Thanks for working so hard to make people well. That is one hell of a job.

  30. I’ve been fighting hashimotos for about 6 years, my antibodies are too high to measure and I’ve taken ldn for several years and it’s done nothing, hasn’t improved how I feel and hasn’t lowered my antibodies.

  31. Diagnosed with Hashimotos 6 months ago. Antibody count was in the 30s… started 3mg LDN and Novembers bloods showed antibody count of around. Been 1 week without LDN and I am panicky anxious and palpitations are out of whack. Getting back on LDN asap

  32. After reading this all I can say is thank God for innovative doctors. I sure am thankful for people like Alexander Flemming, Friderich Serturner, and countless others who didn’t wait around for someone else to figure it out.
    It takes a great passion in order for someone to really dive into something innovative. Clearly the author of this blog post is not passionate about exploring the potentials of LDN. I think any replies other than to share a study like he wishes to see (and doesn’t exist, and probably never will for the reasons the author mentioned) is only going to fall on deaf ears/blind eyes. My recommendation is to find a good functional medicine practitioner. It seems they are few and far between but the are out there!!! I (unfortunately) have limited experience with one (we moved away) and am now on the search for another in my new area. My experience has been that they ARE willing to roll up their sleeves and dig deep to figure out root causes, have an appreciation for the body as a whole (not a narrow, single system focus) and then (if they are trained in conventional western medicine, nutrition, and other naturopathic medicine disciplines) they can provide a very comprehensive treatment plan that encompasses more than simple pill pushing.

    1. Sadly, most alt med providers I’ve encountered order reams of unnecessary lab work and recommend more pills in the form of supplements than a mainstream doctor would ever recommend. You’re not getting what you think you’re getting of alt med.

  33. If you don’t mind sharing whether you are taking any hormones such as levothyroxine or armor or even t3 replacement? Are you still taking the LDN and if so how are you feeling now? I am considering adding the LDN to my levothyroxine and liothyronine treatment to see if it will help eliminate my remaining symptoms from hashimoto’s…

  34. All I know is this:

    I was on naltrexone for 6 months.

    As soon as I stopped taking 50mg of naltrexone for opioid dependency, within 1-2 weeks my hair began falling out (I’ve lost about 50% of my hair in 5 months judging from the diameter of my ponytail), I began gaining weight even after attempting to adjust my diet, began breaking out in hives at random (even in my sleep), began suffering severe muscle and joint pain I’ve never experienced after exercising, and started experiencing fibromyalgia (which I didn’t believe was a “real thing” until recently).

    Thyroid levels were still mildly within defined limits but antibodies were through the roof. Diagnosed with Hashimoto. (600 & 215 respectively)

    I believe my opioid addiction was keeping the Hashimoto at bay somehow, then the naltrexone was binding the same way.

    I’m telling you – I know my body. AS SOON AS I stopped taking naltrexone, I felt severely fatigued all the time, like I had been hit with a bus. I don’t need to read a clinical double blind study to realize this: half my hair is GONE, and I’ve felt like I’ve been trapped in someone else’s body for the last 5 months.

    I started the 50mg dose again 2 days ago after a miserable 5 month hiatus.

    Perhaps the timing of stopping the naltrexone and the development of the Hashimoto symptoms was just extremely ironic.

    If my energy improves, pain improves/subsides, antibodies decrease, and my hair starts growing back (which should be easy to notice since I’m female and my hair line has receded a quarter inch), then I’m going to go ahead and call one win for the naltrexone side.

    Ali, RN

  35. As of two days ago, I stopped taking LDN. I had been taking it for a while and then I stopped for a few months. (My new endo suggested I stop, not a naturo) During that time, I felt like my depression got bad and I thought maybe the LDN was helping. I went back on It and noticed my depression was better, but the problem is I don’t know what this will do to me long term, What is this going to look like in 30 years? For me, there are not enough studies to back it up. Also, I notice I’ve been having neck issues and I wake up feeling like crap. Of course, supporters of LDN will tell me has nothing to do with it, and it’s not possible. After doing lots of digging, yes, it is possible. Those side effects are linked to LDN. I just don’t think we know enough about it and that’s a concern for me. All I can find on Google are articles telling me how wonderful it is. Confusing.

  36. After 2 years of being on LDN as a last resort, all of my thyroid nodules have gotten smaller. My thyroid function has improved and my chronic pain and fatigue has improved. My confirmation for this was actually from my traditional doctor who does not believe in LDN. They were the ones who informed me that the nodules had gotten smaller. I know this is not the case for all who try LDN but I’ve had great results. I’m only taking LDN, thyroid meds, and vitamin d and sometimes cbd or over the counter Tylenol. I really hope that some research can be done in the future to prove that this can actually help some with Hashimotos. For years doctors dismissed all my symptoms and ailments. It was frustrating. Life sucked. For a long time. I finally feel semi normal again. 😊

  37. LDN has improved my fibromyalgia. Not sure if it’s helping the Hashi’s disease. At first i did need to drop my cynomel dosage.

  38. I’m another positive LDN anecdote.
    I take LDN for a deluxe fibromyalgia, ME/CFS, and Hashi’s combination platter. LDN has increased my energy level and decreased inflammation as measured by my TNF-alpha, IL-6, IL-3, IL-2a, and IL-17 levels. I have also been able to decrease my Armour Thyroid dosage by 50%. I have had ME/CFS for 29 years (post infectious mono-nucleosis) and tried dozens of things that didn’t work. I doubt this is placebo effect, as I absolutely didn’t expect it to do diddly squat.
    Sadly, I can’t speak to Hashi’s on its own. I am not a good study candidate as I use Cymbalta (an NSRI) for Fibro pain and ketoprofen (NSAID) for inflammation. Studies that isolate for specific effects will never include those of us who are moderately to severely ill, as we don’t have a single, isolated disease. We tend to have autoimmune issues in clusters

    1. Excellent points, Rill. While people in your demographic would not be good study candidates, they might be good for a personal trial of such a strategy when nothing else has seemed to work. Glad it helped you.

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