Low Dose Naltrexone (LDN), Hashimoto’s, and Hypothyroidism

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If there was a low-cost, safe medication that could potentially lower your thyroid antibodies, would you take it? Would you expect your doctor to tell you about it? If you answered yes to these questions, and you’re not aware of treatment with low-dose naltrexone – known as LDN – you’ll want to explore this Q&A on this innovative but relatively unknown therapy.

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In September 2022, the Paloma’s Speaker Series webinar focused on using LDN for Hashimoto’s and hypothyroidism. (You can view the full event video at the Paloma site.) The expert panel included McCall McPherson, PA-C, a licensed and nationally certified Physician Assistant and founder of Austin, Texas-based Modern Thyroid Clinic, a practice focused on thyroid care. McCall is also a national patient advocate and the owner of Thyroid Nation, a large thyroid advocacy platform. In her practice, McCall regularly prescribes LDN for many of her patients.

Also joining Paloma for the event was Julia Schopick, a lifelong patient advocate, bestselling author, and creator of the Honest Medicine blog, podcast, and book series. Julia’s bestselling first book, Honest Medicine: Effective, Time-Tested, Inexpensive Treatments for Life-Threatening Diseases, featured a section on LDN. She then focused solely on LDN as a treatment for autoimmune disorders in her second book in the series, The Power of Honest Medicine: LDN, An Inexpensive Alternative to the Costly, Toxic Medications Doctors Prescribe for Autoimmune and Other Diseases. The book features stories from patients across the globe who have had success taking LDN for autoimmune diseases and other health conditions.

During the event, McCall and Julia shared their wisdom, experience, and expertise on LDN with several hundred live viewers. We’ve consolidated some of the key points here in this article.

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Naltrexone is a drug that is used at higher doses of 50 milligrams or more as an opioid receptor blocker or opioid antagonist. Opioid receptors respond to endorphins, the chemicals produced by your body that produce feelings of well-being. By blocking the receptors to opioids, naltrexone blocks the effects of opioids and has become a valuable part of a treatment plan for addictions to alcohol and drugs. (Note that some physicians and patients confuse naltrexone with naloxone, also known by its brand name Narcan, which is the drug used to help reverse the effects of opioid overdose.) Naltrexone is also included with an antidepressant in the weight loss medication Contrave because it helps reduce cravings.

Low-dose naltrexone – known as LDN – is an entirely different therapy unrelated to addictions. The beneficial effects of low doses of naltrexone were first discovered by Dr. Bernard Bihari several decades ago. According to Julia Schopick, while Dr. Bihari was treating heroin addicts with naltrexone, he found that the drug was also stopping the progression of HIV/AIDS in some of these patients and appeared to have potent immune-modulating benefits. Determined to figure out how low a dose of naltrexone would still be effective, he discovered that a dose of 1.5 to 4.5 milligrams could help the immune system with minimal side effects. It’s thought that because LDN slightly blocks opioid receptors, the brain gets the message that endorphin levels are low and naturally produces more, helping to modulate the immune system.

Dr. Bihari went on to try LDN with a multiple sclerosis patient, and according to Julia, “it stopped her MS in its tracks. Word got around that Dr. Bihari was treating people with autoimmune diseases in New York City. And people came to him.” Julia said, “He was the messenger, the pioneer, and the inventor!”

Thanks to advocates – including Julia Schopick – the use of LDN in Hashimoto’s patients has grown in recent years. LDN appears to have anti-inflammatory effects and helps reduce inflammatory markers, which may help slow the thyroid gland’s destruction in Hashimoto’s. In addition to a reduction in antibodies, some thyroid patients who take LDN report needed reduced dosages of their thyroid medications, and experienced improvements in mood, increased energy, less body pain, and better immune function.

Since its inception, LDN has faced an uphill battle with the conventional medical world. During the Paloma Speaker Series, Schopick shared the experience of Dr. Bihari, whose previous work was highly respected and heavily published in numerous prestigious medical journals. Dr. Bihari wrote many groundbreaking papers on LDN, but not one was published, likely due to a quiet embargo by the medical establishment. “Had he been allowed to publish case studies in reputable magazines and journals, I believe that LDN would have become the standard of care way back then. But it wasn’t.”

Today, LDN competes with some of the most expensive, heavily-marketed big pharma drugs prescribed for autoimmune diseases. And because a generic, off-label drug like LDN can’t be marketed to autoimmune patients or doctors or patented, drug companies have no profit motive to sell it, and many doctors remain largely unaware of it.

The use of LDN is also controversial because naltrexone is only FDA-approved for addiction treatment. It’s prescribed as “off-label” as a treatment for autoimmune conditions. Writing off-label prescriptions – prescribing a drug for conditions not officially designated by the FDA – is a fairly common practice, and it’s legal. But without FDA approval, LDN can’t be manufactured, marketed, or explicitly promoted for this purpose.

According to McCall, “We can’t look for an FDA-approved medication ‘on-label’ to help us with Hashimoto’s because medicine still hasn’t caught up to the fact that that’s even possible yet. So that also means it won’t be approved by your insurance, likely need to get it from a compounding pharmacy.”

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McPherson states, “When I deal with an autoimmune thyroid patient, whether it’s Hashimoto’s or Graves’, we want to fix their hormones. But in addition, and completely separate from that, we want to try to influence their antibodies. For Hashimoto’s patients, if we can decrease their antibodies, it shows a risk reduction for developing other autoimmune diseases. The type of medicine I practice views those antibodies as a direct correlation to your level of inflammation. There are a lot of things that influence our inflammation— food, our gut, our genetics, our environment, our stress, all of these things. Some of them are a lot more modifiable than others. LDN, irrespective of the source of inflammation, simply takes the volume on the inflammation and turns it down.

It’s thought that LDN blocks a tiny amount of our endogenous opioids and suppresses it enough to encourage the body to produce more natural opioids. McPherson says, “Your body surmounts that deficit, and it leaves you in a state of excess opioids, which reduces inflammation. We know in the world of functional medicine that autoimmune diseases are driven by inflammation, so if we can find ways to reduce people’s inflammation, we can reduce the burden of their autoimmune disease and reduce antibodies.”

In addition to reduced antibodies, Hashimoto’s patients have reported that LDN improves their symptoms, including fatigue, lethargy, and aches and pains.

LDN has some additional benefits. It’s being studied as a potentially effective COVID-19 treatment, and new studies are finding that LDN may be an effective treatment for Long Covid!

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The recommended dose of LDN for an autoimmune disease like Hashimoto’s and patients with an underactive thyroid ranges from 1.5 to 4.5 milligrams. According to McPherson, “Most people start at 1.5 milligrams of LDN. And they increase over a few weeks to a total of 4.5 milligrams, roughly one-tenth the traditional dose of naltrexone.”

LDN is typically taken at night. Says McPherson: “Its peak effects hit about four hours after you take it and can make you feel sleepy. You want to sleep through that. People might wake up a little groggy, but it’s usually minimal and wears off either a week or two after you start the medication.”

McPherson states, “You can take LDN with most everything except pain medications, opioids, codeine, and anesthesia.”

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LDN treatment is not toxic and has very few side effects. According to Schopick, “Most of the side effects are good, like increased energy and improved mood. There is one side effect I want to make people aware of; some people get vivid dreams, but that’s often resolved after taking it for a while.”

McPherson agrees. “I’ve put between 100 to 200 people on LDN a year, and I might have two or three people a year who stop it due to side effects. In my opinion, LDN is extraordinarily well tolerated. 98% of people take it before bed. The number one side effect is vivid dreams."

In her book, The Power of Honest Medicine, Schopick wrote about a woman with psoriasis who had trouble taking LDN at night, so she switched to taking it in the morning, with excellent results. “With psoriasis, you cannot have a placebo effect. She showed me pictures, and her rash went away with the LDN, taking it in the morning!”

A caution: You can’t take LDN with pain medications, opiate drugs, and anesthesia because LDN blocks the pain-relieving effects. So, says Schopick, “You need to stop taking LDN before having surgery.”

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McPherson counsels that people taking LDN should be patient and not expect immediate results. “From 5 to 8% of people completely their lives change in three days to two weeks, and they’re shouting it from the rooftops because, for them, it’s a miracle. I think it falsely sets a bar for people. What I found in my practice is that it’s a long game. I’ve found that LDN will continue to reduce people’s antibodies and their inflammation for up to 18 months before their total level of inflammation levels out. So, I encourage people not to give up on it too early.”

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LDN is not a one-size-fits-all cure for Hashimoto’s, and it doesn’t work for everyone. Says McPherson: “Some people’s antibodies will slightly reduce, or just stay the same. There are outliers, for sure. But the vast majority of people show great responses on their antibodies, and their joint pain, overreactive gut issues, and overreactions to food improve. I personally will be on LDN forever for cancer protection and protection against autoimmune diseases.”

McPherson describes an experience with one Hashimoto’s patient. “I saw their antibodies drop 500 points in three months. There are not many ways outside of LDN that can elicit that kind of a response in antibody levels!”

At the website LDN Science, Vivienne Smith, a Hashimoto’s thyroid patient, described ten years of struggling with symptoms, despite treatment with thyroid replacement hormone drugs. Vivienne reported that just three weeks of LDN treatment improved her energy and stress levels and enabled her to resume a more active life.

You can read various other patient success stories about the use of LDN for autoimmune disease in Julia Schopick’s book, The Power of Honest Medicine.

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LDN is not a manufactured and labeled drug available at regular pharmacies. It needs to be specially prepared by a compounding pharmacy. The good news is that compounded LDN is not particularly costly. Most patients don’t pay for than $50 a month for LDN. Because it’s prescribed off-label, however, LDN is typically not covered by health insurance.

If you’re looking for a doctor to prescribe LDN, the good news, according to Schopick, is that “more and more doctors are prescribing LDN for their patients. In fact, patient advocates have lists of doctors from all over the US and abroad who are on the ‘LDN bandwagon.’”

But finding a doctor to prescribe LDN can be a challenge. Schopick has this advice. “Do your research. Bring scholarly articles and information to your doctor.” Schopick also recommends that patients check out the LDN Facebook groups. Patients freely share information about doctors in their areas, making these groups a “wonderful resource.”

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According to McPherson, “You can stay on it forever. I tell my patients that there are more and more studies coming out in support of the long-term use of LDN. So many of our health issues are inflammatory-based. And if you have an easy way to mitigate that, I advocate for being on it forever. I’m on it forever!”

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If you have a physician willing to prescribe LDN, keep in mind that it is inexpensive and doesn’t come with significant risks or side effects. In other words, the worst-case scenario when trying LDN is that you it won't work for you, and you're one of the people who don’t find it helpful.

On the other hand, the best-case scenario is that it will be effective at lowering your thyroid antibodies and reducing -- or in some cases even eliminating -- your thyroid symptoms! Either way, it’s highly unlikely to cause any problems or significant side effects, and you won’t need to spend hundreds of dollars!

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If you have Hashimoto’s or hypothyroidism and start LDN therapy, it’s essential to watch for hyperthyroidism symptoms that may indicate your medication dosage should be reduced. You should also periodically recheck your thyroid hormone levels. The Paloma Complete Thyroid Test kit makes it easy and affordable.

Many thyroid patients get comprehensive diagnosis, management, and optimal treatment of hypothyroidism with Paloma’s top thyroid doctors. Paloma’s thyroid-savvy team of doctors works with you to develop a thorough and effective treatment program, including the best thyroid medication that can safely normalize your thyroid function and best resolve your symptoms. You can also ask your Paloma patient advisor to help you find a Paloma practitioner with experience prescribing LDN.

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For more information on the use of LDN for thyroid conditions, autoimmune diseases, and other health challenges, check out these helpful resources:

• LDNInfo.org, a website created and maintained by LDN expert Dr. David Gluck, a colleague of Dr. Bihari
• LDN Research Trust, created by Linda Elsegood
• The LDN Research Trust on Facebook
• Beating Thyroid Disease with LDN on Facebook
• Directory of physicians prescribing LDN

Julia Schopick has also graciously offered to send Paloma readers copies of relevant studies on LDN to share with your doctor. For more information, email her at Julia@HonestMedicine.com with your request. For information on her series of books, visit her website at http://www.HonestMedicine.com.

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