Note: Originally published in February 2015, this article has been revised and updated for accuracy and thoroughness.
In 2015, I conducted a survey of over 2000 readers with Hashimoto’s asking for the most helpful interventions in their health journeys.
One reader wrote: “Low Dose Naltrexone changed my life for the better. If I had not added that to my regimen, I would still be suffering from nerve pain and uncontrollable allergy symptoms, in addition to the problems I have from the Hashimoto’s.”
While only 38% of those that tried Low Dose Naltrexone reported feeling better, the ones that saw benefit had some spectacular results. 48% were able to reduce thyroid antibodies, 61% saw an improvement in mood, 66% were able to have more energy, and 40% saw a reduction in pain.
I have personally seen this medication change people’s lives and wanted to share some more information on it, in case you have hit a plateau of your healing journey.
What is Low Dose Naltrexone (LDN)?
Naltrexone is an FDA-approved medication used for opioid withdrawal at a dose of 50 mg per day. However, low doses of this medication have been found to tweak the immune system and have shown promise in improving cases of autoimmune disease including Crohn’s, MS, and Hashimoto’s, as well as other immune system-related conditions such as cancer and HIV/AIDS.
Doses of 1.5 – 4.5 mg per day are usually recommended and have been reported to enhance immune function through increasing our endogenous endorphin production, reducing inflammation, promoting DNA synthesis, and slowing down motility in the GI tract to facilitate healing.
Low dose naltrexone (LDN) balances the immune system by increasing the amount of T-regulatory cytokines and modulating TGF-B, leading to a reduction of Th-17, the promoter of autoimmunity. This means that it turns off the cells that cause autoimmunity!
This medication is available only as a prescription and can be compounded into lower doses by special professional compounding pharmacies. Luckily, even without insurance coverage, this medication is available in generic form and is very affordable, usually costing between $15-$40 per month.
The websites dedicated to sharing research are Low Dose Naltrexone (LDN) and LDN Research Trust. They are full of testimonials about ulcers, tumors, and lesions disappearing within months of initiating LDN.
The authors of the website even caution users with Hashimoto’s taking supplemental thyroid hormone to start low (1.5 mg per night) and to watch for emerging signs of hyperthyroidism that may result from rapid improvement of the condition.
I decided to interview Dr. Mark Mandel, PharmD, compounding pharmacist, LDN expert and fellow Midwestern University Chicago College of Pharmacy Grad, on the effects of LDN in people with Hashimoto’s and autoimmunity. Dr. Mandel was kind enough to share his knowledge with me.
INTERVIEW WITH DR. IZABELLA WENTZ, PHARMD AND DR. MARK MANDEL, PHARMD
IW: What types of people benefit from LDN?
MM: We have seen amazing results with people with autoimmune conditions, cancers, and neuropathic pain.
IW: How is LDN thought to work for autoimmune conditions?
MM: The exact mechanism has not been determined, but the theory is that LDN increases endorphin activity two to three fold. Additionally, it may increase the numbers of endorphin receptors and/or the sensitivity of the receptors. The increased endorphin activity results in better modulation of the immune system.
IW: How is LDN taken?
MM: The typical starting dose for people with Hashimoto’s, fibromyalgia, and MS is 1.5 mg every night at bedtime but may be even lower depending on the individual. The target dose will come down to the individual patient, and we often need to titrate it. At times, the condition may be dynamic, and we may need to change the dose of LDN just as you would with other medications such as thyroid drugs. (Note: To help you even further, I’ve created an eBook Optimizing Thyroid Medications you can download for free.)
LDN can be taken in the form of a compounded tablet, capsule, liquid, or transdermal formulation. We often find that the transdermal (skin) or sublingual formulations work best for those with liver issues. The transdermal formulation is recommended for children with autism.
For people who are new to LDN or for those with swallowing issues (dysphagia), I will usually recommend starting with a liquid formulation. That allows us to figure out the correct dose for each person.
IW: What are some of the more common adverse reactions that people have to LDN?
MM: Sleep disturbances, nausea, and irritability are some of the issues that people report.
For those that have nausea, we have found that using a sublingual dose seems to help. In cases of sleep disturbances, we recommend adjusting the dose to morning time instead.
For those who have become irritable after taking LDN, I would recommend reducing the dose. While 1.5mg is a typical starting dose for Hashimoto’s, some may do better with a starting dose of 0.5 to 1mg. This is where the liquid LDN allows us to get a minute dose and gradually progress to a target dose. I like to use the old pharmacy adage that applies to most medications: “Start low and go slow.”
Liver toxicity has been reported with the full dose naltrexone but none that I have encountered with the low dose naltrexone. However, we always recommend liver function tests while taking this medication.
IW: What types of benefits can be seen with LDN for thyroid disorders?
MM: Once you have been titrated to the correct dose, you will start feeling better. This will usually be followed by an improvement in labs, such as improved markers in TSH, T4, T3, and TPO levels. The time to start feeling better will, of course, vary per person. Once you start to feel better, maintain the dose for 2 – 3 months, and follow-up with your physician to see if your laboratory markers have improved. I recently had a patient with hyperthyroidism who struggled with trying to get pregnant for many years and was finally able to get pregnant after starting LDN.
IW: Speaking of pregnancy, is LDN considered to be safe during pregnancy?
MM: Yes, all of the literature does seem to indicate that LDN is safe during pregnancy. (Dr. Wentz’ note: I have found studies that have used full dose naltrexone during pregnancy for opiate-addicted mothers.)
IW: Is LDN a life-long drug?
MM: Not necessarily. We have experienced patients with chronic neuropathic pain who had used LDN for a limited time period and was able to stop it, and if you are a young person with Hashimoto’s, you can go into remission through modulating your immune system with LDN. The medication will help you move towards an appropriate immune status, and once the immune system is in balance again, you may be able to get off the LDN.
IW: What advice do you have for those considering the use of LDN?
MM: LDN should be used as part of an arsenal to help you overcome your autoimmune condition. Appropriate levels of vitamin D, full spectrum light exposure, and food sensitivities all play a role in autoimmunity and need to be considered as well. It’s also best to work with a compounding pharmacy that can help you titrate your dose correctly.
Dr. Mark Mandel, PharmD has two pharmacies in the Chicagoland area. The pharmacies provide compounding services (including LDN and thyroid hormones), hormone balancing solutions, and a Mastectomy Boutique that can be found at the Roselle location.
For best results…
As those of you that have read my book will know, the immune system can be thrown off balance by a variety of factors. Some of those factors include food sensitivities, infections, or an imbalance in gut bacteria. Thus, I always recommend using LDN as a part of a whole person approach and not as a standalone therapy for best results and for increasing your chances of remission.
I also want to stress that LDN is not a cure, but rather an immune modulator that can be used to prevent further damage to the thyroid while one is looking for their root cause or to rebalance the immune system when the root cause cannot be found.
LDN is not a commonly prescribed medication, and it may not always be possible to convince your doctor to prescribe it. On my quest to try LDN, I talked to my local compounding pharmacist to figure out which doctors in my area were knowledgeable about prescribing LDN.
LDN was one of the first interventions that I tried on my thyroid journey back in 2009. As a pharmacist, I was looking for the magic immune system pill, but I found that it made me somewhat irritable after a few nights of taking it, so I gave up on it and moved on to something else. Instead of working with a compounding pharmacist, I made the mistake of getting full strength naltrexone and compounding it myself.
As I mentioned in Root Cause, I also used LDN before I started working on my diet. Had I worked with a knowledgeable professional, I would have learned that LDN works best when used alongside a leaky gut diet. Additionally, according to Shannon Garrett, RN- LDN may not work if someone has a candida overgrowth. In addition, for improved tolerability, titrating the dose is necessary.
It took me over three years to get myself in remission. I hope that with the information I share in my book and on this blog, you will be able to get yourself into remission more quickly and efficiently.
You can also download a free Thyroid Diet Guide, 10 Thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter for free by going to www.thyroidpharmacist.com/gift. You will also receive occasional updates about new research, resources, giveaways, and helpful information.
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- The Low Dose Naltrexone Homepage. Lowdosenaltrexoneorg. 2017. Available at: http://www.lowdosenaltrexone.org/. Accessed July 11, 2017.
- LDN Research Trust – Low Dose Naltrexone |. Ldnresearchtrustorg. 2017. Available at: http://www.ldnresearchtrust.org/. Accessed July 11, 2017.
- Wentz I, Nowosadzka M. Hashimoto’s Thyroiditis. 1st ed. Wentz LLC; 2013.