Q:  Do I use Low Dose Naltrexone also called LDN for Hashimoto’s? 

A.  First, let’s learn more about LDN.  Naltrexone is a medication that was approved by the FDA to treat opioid addiction in the 1960’s.  The dose used for this is between 50-100mg or higher.  Physicians started noticing it had other properties that helped with pain and acted like an anti-inflammatory when used in very low doses (4.5mg).  Studies evaluating low dose naltrexone in many conditions started around 2007.  Small studies looking at fibromyalgia reported improvement in symptoms.  Investigations looking at the anti-inflammatory properties have reported a decline in many of the anti-inflammatory markers like sedimentation rate, TNF-alpha & interleukin-6 in a variety of conditions like Chron’s, Multiple Sclerosis and Regional Pain Syndrome.  They feel like it may be neuro-protective (meaning it protects the nerves) and helps with pain like an analgesic.  It may also play a role in boosting the immune system and therefore is being tried in conditions like cancer.

Because LDN appears to have anti-inflammatory properties it is being tried for other inflammatory conditions like Hashimoto’s which is an autoimmune thyroid condition.  LDN is NOT a cure for Hashimoto’s but is used with the theory of protecting the thyroid and possibly helping the immune system while you look for the underlying cause.  Many things have been implicated as the cause of Hashimoto’s including viruses, bacteria and food sensitivities.  In my experience, most of the time removing offending foods and adding a few key supplements will start turning this condition around.    If this doesn’t help then LDN may be a something to consider but I don’t use it as a first line of treatment.  If you do try LDN make sure you start with very low doses (usually around 0.5mg) and work up very slowly, monitoring your thyroid every step of the way.  Often the dose of thyroid medication needs to be adjusted while taking this medication.

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Why is this a not well known medication?  The FDA approved regular dose of Naltrexone is well known for treatment of drug withdrawal. However, it is considered “off-label” when used at the lower dose and is not a main stream treatment.  Although there are several small studies using LDN for Chron’s, Multiple Sclerosis and inflammation,  medicine has a tendency to completely discount small studies.  Compounded naltrexone is a relatively inexpensive medication so big pharma is not going to sink any money into larger studies. More research needs to be done with this medication because it does have some promise and it is needed to help answer the question of safety concerning long term usage.

LDN appears to be well tolerated with few side effects.  Some people experience very vivid dreams or mild headaches.  In a few cases,  anxiety and a rapid heart beat have been reported.  Liver toxicity is a concern with the full dose of Naltrexone (50mg or higher) but has not been seen with LDN.  It’s always a good idea to monitor liver function tests regardless.  Long term studies on this dose have not been done so it’s important to be followed regularly.

Naltrexone is only available in 50mg or higher doses and is not available in the low dose commercially so it must be compounded.  Fillers like calcium carbonate might interfere with LDN so avoid this combination (ask your compounded what fillers they are using).

Bottom line:  LDN is worth a look if you are faced with continued inflammatory issues in spite of modifying your diet and addressing any underlying cause.