Everything You Need To Know About Naltrexone For Hashimoto's Thyroiditis

Historically, the drug naltrexone (brand name Revia or Vivitrol in the US) treats opioid or alcohol dependence. By classification, naltrexone is an antagonist drug, meaning it blocks the effects of another drug. For example, in a person undergoing addiction treatment, prescription naltrexone will prevent a typical “buzz” or high when using alcohol or opiates. So, a key reason to use that substance goes away, helping to break the addiction cycle. Other supports, such as counseling, are often necessary to the recovery process. The FDA first approved naltrexone as a treatment for heroin addiction in 1984.

Beyond addiction treatment, physicians report¹ benefits of administering low-dose naltrexone therapy(LDN) to treat conditions involving inflammation or faulty immune response, such as fibromyalgia,² Crohn’s disease, multiple sclerosis, complex regional pain syndrome, and cancer.,Through this lens, LDN has potential as a possible emerging treatment for Hashimoto’s thyroiditis—an autoimmune disorder characterized by the immune system attacking healthy thyroid tissue and inflammation of the thyroid gland.

So far, there is a distinct lack of clinical research to validate the effectiveness of LDN to treat Hashimoto’s thyroiditis. However, the lack of adequate studies examining naltrexone’s effectiveness for this disorder may be due to low financial incentives. LDN is a relatively inexpensive oral pharmaceutical, with a monthly prescription costing roughly $30–50/month in the US. Therefore, scientific and community advocacy may help compel research funding more than profitability.

To be clear, LDN is not yet a fully approved or evidence-based treatment option for Hashimoto’s thyroiditis, so much as an area of research interest. Still, anecdotal reports from doctors³ do suggest LDN has benefit and underexplored potential for treating a multitude of immune-related conditions. This article explores what scientists, doctors, and pharmacologists (experts in the way drugs interact in the body) currently know about Hashimoto’s disorder and how LDN may fit into treatment options.

So, what is Hashimoto's thyroiditis?

Your thyroid gland is responsible for producing hormones that regulate metabolism, growth, and development. Hashimoto's thyroiditis (also known as Hashimoto’s disease) is when your body’s immune system attacks the thyroid gland (located in your throat). One indicator for this autoimmune disorder is low thyroid hormone levels. As a result, many different bodily processes slow down—like converting food to energy. As a result, Hashimoto’s thyroiditis can leave you feeling weak, tired, depressed, and irritable. 

Hashimoto’s thyroiditis impacts people of all ages, but it’s most common among females in their mid-forties to mid-sixties. Currently, Hashimoto’s thyroiditis does not have a cure. Still, it is treatable once diagnosed by a qualified healthcare professional, such as an endocrinologist (a doctor specializing in hormonal health).  

Hashimoto's thyroiditis signs and symptoms

In addition to thyroid inflammation, common symptoms include:

• Goiter (swelling in the throat)

• Weight gain

• Fatigue

• Loss of appetite

• Dry skin, brittle nails

• Increased sensitivity to cold

• Memory loss

• Muscle weakness

• Hair loss

• Depression

• Irritability

• Constipation 

• Menstrual cycle changes (irregular or heavy period)

• Low sex drive

• Infertility

Current treatment options for Hashimoto’s thyroiditis

Today, the go-to treatment for Hashimoto’s thyroiditis consists of synthetic thyroid hormone replacement medication (T4 replacement) taken daily for life.

While many people with Hashimoto’s thyroiditis attain an improved quality of life with thyroid hormone replacement therapy, research⁴ indicates that physicians sometimes grapple with determining a patient’s ideal dosage. Regular monitoring (blood testing) is necessary so that T4 replacement amounts can be adjusted as needed.

Additionally, suppose a person with Hashimoto’s thyroiditis has other health factors to consider, such as anxiety, heart issues, or a history of insomnia. In that case, T4 replacement may not be a viable treatment option.

What’s the difference between naltrexone and LDN?

Naltrexone is an FDA-approved medication first manufactured in 1965 and approved to treat Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD). In this use case, Naltrexone is usually prescribed at a dose of 50 mg per day and taken for around six months. However, some patients may require more prolonged treatment. A 2021 article³ authored by Lisa Barr, MD, founder of the Regenerative Medicine Center in Virginia, states that a low dose of naltrexone (LDN) typically “starts at 1mg and increases monthly to a max of 4–4.5 mg.” Preliminary research indicates that LDN can modulate the immune system and help to treat autoimmune disorders⁵ such as multiple sclerosis, Crohn's disease, rheumatoid arthritis, and immune-mediated conditions such as HIV/AIDS and cancer — but it remains an experimental treatment.

How do they work? 

Naltrexone works by blocking opioid receptors in the brain and central nervous system to reduce the addictive effects of opioids—it blocks the opioids from binding to the receptor. As a result, the euphoric feeling associated with using opioids doesn’t happen, which helps people stop using opiates.

Low-dose naltrexone (LDN) helps regulate the immune system by reducing the production of the stress hormones cortisol and adrenaline. Cortisol gets made in response to severe stress, such as physical or emotional trauma.  Adrenaline and cortisol work together in complex ways to help regulate your body's immune system. However, when these responses become excessive (overreactive), they trigger chronic inflammation or autoimmune diseases. The exact mechanisms by which LDN may improve Hashimoto’s thyroiditis are not well understood or demonstrated reliably in clinical research.

The exact mechanisms by which LDN may improve Hashimoto’s thyroiditis are not well understood or demonstrated reliably in clinical research. A few of LDN’s properties that need more investigation include:

• The way it blocks proteins and impacts the nervous system

• Its anti-inflammatory effects

• Potential immune system balancing properties

• Effects on endorphins (natural pain killers made by the human body)

What are LDN’s potential side effects?

LDN is considered non-addictive. The most common side effects associated with LDN are:

• Temporary sleep disturbances 

• Mild headaches

(Naltrexone at higher dosages, as used in treatment for substance use disorders, is known to have more potential side effects, such as nausea, drowsiness, headache, dizziness, decreased appetite, painful joints, muscle cramping, sleep disturbances. At high doses it can cause liver problems).

Is LDN safe during pregnancy?

Naltrexone is proven helpful for treating opioid use disorder in pregnant women. A 2020 study⁶ involving 230 patients found that “the drug is well-tolerated by both mother and fetus.”

However, low-dosenaltrexone in pregnant women with Hashimoto’s thyroiditis has not been clinically researched, so currently, there is no data to support its safe usage.

Can LDN cause complications?

If you are already taking thyroid medication and LDN does improve your thyroid function, that thyroid medication dosage may become too high and cause a hyperthyroid episode.³ This possibility (and other risks) warrants a discussion with your doctor.

Should I choose LDN over conventional T4 treatment?

Conventional thyroid hormone replacement (T4 treatment) for Hashimoto’s thyroiditis is generally safe, effective, and evidence-based. However, if you are not responding well to conventional treatment or have a medical contraindication (a reason why T4 would not be safe or suitable), have a detailed discussion with your doctor about treatment alternatives. In addition, a physician may or may not recommend LDN, as its use for Hashimoto’s thyroiditis is a topic of controversy and still considered experimental.

The lowdown

The use of low-dose naltrexone to treat health conditions other than opioid or alcohol dependence is still in its early days and not reliably indicated by research.

Suppose your Hashmito’s thyroiditis is not responding well to conventional treatment like synthetic thyroid hormone replacement, or you are curious about LDN’s potential suitability. In that case, it’s vital to have a detailed discussion with your doctor. Above all, get advice from a qualified health care professional before making any changes to your thyroiditis treatment.

As a subject of scientific study, LDN is controversial, and data is sometimes contradictory. For LDN to gain traction as an approved treatment option for Hashimoto’s thyroiditis, more in-depth, long-term research must substantiate anecdotal reports of its effectiveness.