I get a lot of questions about low dose naltrexone (LDN), and while I’ve written about this in the past, I figured I’d put together a quick “5 things to know” post, which includes a few resources for those who are interested in taking LDN. LDN of course isn’t specific for those with thyroid autoimmunity, as it has been shown to help with other autoimmune conditions (i.e. multiple sclerosis), as well as fibromyalgia, complex-regional pain syndrome, and cancer. The good news is that it’s readily available and relatively inexpensive, but as you’ll read, there are some potential downsides as well.
So let’s take a look at the five things people with Graves’ disease and Hashimoto’s should know about LDN:
1. Low dose naltrexone acts on the immune system. LDN, when taken in a daily dose of 0.5 to 4.5 mg, has the ability to modulate the immune system. This could be of benefit to people with different types of autoimmune conditions, including Graves’ disease and Hashimoto’s thyroiditis. Most people with Graves’ disease are told to take antithyroid medication (or receive radioactive iodine), and many people with Hashimoto’s are told to take thyroid hormone replacement. This doesn’t mean that these aren’t necessary, as the reason why antithyroid medication is commonly prescribed is because it is very effective in lowering thyroid hormone levels. And of course many people with Hashimoto’s do need to take thyroid hormone replacement.
When LDN works well it can do wonders, as for those with Hashimoto’s it might allow them to stay off of thyroid hormone replacement (or to take a lower dosage), and for those with Graves’ disease it might allow them to avoid antithyroid medication (or to take a lower dosage). The problem is that LDN isn’t effective in everyone who takes it, which is one reason why it’s not recommended initially. This is especially true with Graves’ disease, as if someone has overt hyperthyroidism most endocrinologists would prefer for their patients to take a medication that has a greater likelihood of lowering thyroid hormone levels, even though antithyroid medication is much more likely to cause side effects than LDN.
2. LDN doesn’t address the cause of Graves’ disease or Hashimoto’s. Most people reading this probably know that LDN doesn’t address the underlying cause of the condition. According to the triad of autoimmunity, in order for an autoimmune condition to develop you need the following three factors 1) a genetic predisposition, 2) an environmental trigger, and 3) a leaky gut. Obviously there is nothing you can do to eliminate the genetic predisposition, but you can remove the trigger and heal the gut. When someone takes LDN and it works well it might feel like the person is in remission, and the thyroid panel and thyroid antibodies might even normalize. But in this situation, if someone were to stop taking the LDN then over time their lab markers would probably get out of range again.
Of course this doesn’t mean that you can’t take LDN while at the same time trying to address the cause of the problem. Some wonder how they would be able to tell if the cause has been addressed if they’re taking LDN. For example, if someone with Graves’ disease or Hashimoto’s took LDN and their thyroid antibodies normalized due to the medication, and at the same time they took action to find and remove their triggers, how would they know if the underlying cause was addressed, or if the antibodies were normal solely due to taking LDN? This admittedly could be tricky, and the only real way of knowing is for the person to eventually wean off of the LDN and see if the thyroid antibodies remain normal over time.
3. LDN can negatively affect sleep. Sleep disturbances are one of the more common side effects of LDN. Some people will also experience nightmares. This can be a big problem, as a lot of people already have difficulty falling and/or staying asleep even without taking LDN. Many times this will be resolved by taking LDN during the day (it’s commonly given at night), although this isn’t always the case.
4. Getting a prescription for LDN in the United States isn’t too difficult. For those who choose to take LDN, while it would be great if you have a medical doctor who is willing to prescribe LDN, if not there are other cost-effective options. One option is to visit the website www.ldnscience.org/ and search for a doctor in your area that prescribes LDN. If you live in a different country you might also be able to find a local practitioner who is willing to prescribe LDN. For those who live in the United States who can’t find a local practitioner who will prescribe LDN, you might want to check out the websites ldndirect.com and ldndoctor.com, as you can schedule a one-time phone consultation to speak with a practitioner who will prescribe LDN.
5. LDN probably isn’t a good first option for those with Graves’ disease. Since some people don’t do well with antithyroid medication, you might wonder why those people with Graves’ disease shouldn’t consider taking LDN initially. Although this is an option, the problem is that LDN doesn’t work on everyone, and if someone has elevated thyroid hormone levels and cardiac symptoms it is important to get the levels under control as soon as possible. If LDN worked as well as antithyroid medication, or even antithyroid herbs such as bugleweed, then without question it would be a good first option to consider.
How about if someone absolutely doesn’t want to be on antithyroid medication, or if they took antithyroid medication and experienced negative side effects? I usually recommend bugleweed for those who can’t or won’t take antithyroid medication, and this is the approach I took when I dealt with Graves’ disease. This is just my approach, and the reason is because I find bugleweed to be more effective in managing the symptoms of hyperthyroidism when compared to LDN. However, if someone is unable to tolerate antithyroid medication and if the bugleweed isn’t effective in managing their symptoms, then LDN should be considered, although there is also cholestyramine, which I discussed in a separate article.
Should You Take LDN?
Most of my patients with Graves’ disease and Hashimoto’s don’t take LDN. I can’t say that it’s something I commonly recommend, as many of my Graves’ disease patients take antithyroid agents (i.e. methimazole, bugleweed) while many of my patients with Hashimoto’s take thyroid hormone replacement. But even if they’re not taking anything to manage their symptoms I can’t say that I usually advise my patients to take LDN, and the reason for this is because it’s not addressing the underlying cause, and at times it can make it challenging to know if someone is responding to the natural treatment protocol.
That being said, there are times when I’ll recommend LDN, and if someone is already taking LDN when they begin working with me I won’t tell them to stop taking it. I should also add that I don’t only recommend LDN for the purpose of modulating the immune system in my Graves’ and Hashimoto’s patients, as LDN has other functions as well. For example, sometimes I’ll recommend LDN to those who have small intestinal bacterial overgrowth (SIBO). The reason for this is because LDN can act as a prokinetic, which can be important if someone has SIBO due to damage to the migrating motor complex of the small intestine.
But getting back to thyroid autoimmunity, and whether you should specifically take LDN, this of course is ultimately your decision. If you have Graves’ disease and experience side effects when taking antithyroid medication, and if bugleweed isn’t effective in managing your symptoms, then perhaps you should consider taking LDN. It might make more sense for those with Hashimoto’s to take LDN since it can prevent further damage to the thyroid gland from occurring while taking a natural treatment approach. Then again, many people have the antibodies for both Graves’ disease and Hashimoto’s, and so an argument can be made that anyone with elevated thyroid peroxidase (TPO) and/or anti-thyroglobulin antibodies should consider taking LDN. But as I have already mentioned, besides LDN not addressing the cause of the problem, it also isn’t always effective in “calming down” the autoimmune response.
What’s Your Experience With Low Dose Naltrexone?
If you have Graves’ disease or Hashimoto’s and have taken LDN, please feel free to share your experience in the comments section below. If you took LDN and it helped please let me know! If you took it and didn’t notice any difference please let me know! If you haven’t yet taken LDN but are thinking about doing so so please let me know!
My doctor keeps recommending LDN to me for helping with Hashimoto’s, but I keep declining. For one, I don’t want to be on another prescription medicine. Also, as you said, I would rather focus on the root cause. And too, I’ve read from others that it didn’t work for them and actually had some long-lasting negative side effects.
I took ldn for about 6 months, unfortunately it raised my grave’s antibodies slightly and increased my thyroid levels as well. I’m still not opposed to taking it, but giving it a break for now.
I am very interested in taking LDN I have both Hashis and Graves and all the meds have me swinging from hyper to hypo and back! I am on AIP diet etc.
Any info is greatly appreciated.
Thanks Dr Osansky for all the info , I take 2 mg of LDN in the morning .
I started with Graves about 10 yrs ago and went on carbimazole for about a year . Then about 6 years ago I developed an autoimmune kidney disease which no doctor could sort out and I was very unwell that’s when I found LDN and I’ve had no relapse of that since then . I have had a Graves relapse and work with integrative doctor . I did go back on carbimazole but I recover very quickly and antibodies never gone too high . I have addressed diet and gut issues and take other supplements . I also have a degree of TED and have had a cancer diagnosis but all under control and I feel the LDN plays a part in this . My only thing now is I ve started to show some Hashimoto antibodies but no symptoms .
I agree LDN is just part of the arsenal and people that take LDN generally know this and know lifestyle issues have to be addressed too .
I have also now added a small dose of CBD oil and feel this helps with background anxiety so I am feeling well and happy .
I appreciate all the articles you provide , best info
Regards Lyn
I have been on low-dose naltrexone for about three years. I have hypothyroidism and initially it was diagnosed as Hashimoto’s hypothyroidism.
I found it to be very effective in at least two ways. My then naturopathic doctor said he couldn’t believe the difference in me and how healthy and calm I was in comparison to my first visits. I felt calmer, less compelled to say whatever came into my mind, and felt healthier as well.
I’ve been on LDN since January 2020, 3 mg, then upped the dose to 4.5mg about 3 weeks ago. I have had three alcoholic beverages in that time. Each time I tried, I found that I did not enjoy any effects of alcohol, the relaxation and slight buzz. It was neither pleasant nor unpleasant. It is difficult to articulate. The alcohol did not provide me with any relief or comfort as it had in the past. In fact, I felt ambivalent about finishing the drink, even though two of the drinks were spendy $15 craft cocktails in a social setting, (pre coronovirus pandemic). Since it seemed to be pointless, I also have not wanted to follow through when I had alcohol cravings in the past months. I can’t find any other anecdotes about this effect, which makes me wonder if I am imagining it?
Hi Dr. Eric,
First, thank you very much for all your valuable advice and info regarding natural treatment of Grave’s disease.
I’ve been living with this condition for over a year now. Luckily, I “self-diagnosed” it soon after its onset in March 2019, after I noticed a rapid loss of weight and a high resting heart-rate. After lab tests confirmed my suspicion, my GP referred me to an endocrinologist for further treatment. As US imaging of the thyroid detected no abnormalities, I was offered the option of treatment with radio-Iodine or Athyrazol (MMI?). Of course, I refused the RI and decided for medical treatment with Athyrazol, but at the same time I actively started investigating natural ways to treatment. Thus I discovered your valuable website and started to follow your 6 steps to reverse Graves. Although I had never had any known food-related sentivities or allergies, I had the tests done, which revealed a medium sensitivity to wheat and a very high sensitivity to various types of cheese. Thus I immediately excluded gluten and dairy from my diet, but kept eating nightshade vegetables, corn (non-GMO!) and beans as the tests showed no reaction to these. I also started taking various supplements, such as glutamine, L-carnitine, selenium+zinc, multivit.preparation (without Iodine!), and recently also a precursor for glutathione (NAC) and Alpha lypoic acid. All in all, my condition has been slowly but steadily improving, so I needed lower and lower doses of Athyrazol, but my doc was still not happy because in her opinion the TSH levels should be higher although the fT4 and fT3 levels were within normal range and also my eye symptoms have regressed significantly. She suggested a block&replace therapy which means that I should take high enough doses of Athyrazol to maintain an adequate TSH level and since that would make me hypothyroid, I’d take replacement thyroid hormones. To her disappointment, I found this unacceptable and it was at that point that I discovered LDN. Since there is no compounding pharmacy available in my country (Slovenia) and only few naturopathic doctors are willing to prescribe Naltrexone tbls for off-label use, I finally got the prescription and started preparing my own LDN solution (one 50 mg tbl diluted in 50 ml of demineralized water). Initially I was taking 1.5 ml and gradually increased the dose to present 2.5 ml. I ‘ve been having practically no side effects except for more vivid dreams, but otherwise, the positive effects were almost unbelievable: since my doc admitted that she had no idea about LDN and was obviously not interested to learn about it, let alone prescribe it for me, I signed a statement to this effect that I am taking the drug against her recommendation on my own initiative and responsibility, and was scheduled for my next regular follow-up examination in two months. At that time I was still supposed to take 1 tbl (10 mg) Athyrazol daily. A week later I had the feeling that I was already on the Hashimoto side, so I had my blood tests done and indeed not only the T4 and T3 values were decreased, but also the TSH was abnormally high. I reduced the dose to 1/2 tbl and had another test done after two weeks and since the values were still on the Hashimoto side ((TSH 11.11 (range 0.27 – 4.2 mIU/L), T4 4.28 (12-22 pmol/L), T3 3.43 (2.8-7.1). I reduced the dose to 1/4 tbl. I plan to take another test in 2 weeks and if at that time too the levels will still be indicative of a hypothyroid state, I’ll stop using Athyrazol completely and switch to bugleweed tincture (15 drops 2x daily). I intend to maintain LDN at 2.5 ml as it seems to work perfectly well at this dosage. Am I right to believe that I am finally approaching the long expected remission of my Graves disease? And just a general question which really bothers me: Why the standard medicine and its practitioners are so reluctant to admit that even their evidence-based and scientific methods have certain limitations and are often working contrary to the benefits of patients? Why it seems that they are only concerned with treating the disease rather than treating the patient who suffers from it?