Episode - Low Dose Naltrexone and Graves’ Disease


LDN and Graves’ Disease

In this episode Dr. Eric discusses the benefits and risks of low dose naltrexone, and whether those with Graves’ disease and Hashimoto’s should consider taking it.

During this episode you’ll learn:

  • What the research shows about LDN
  • The precautions someone might need to take if they take both thyroid medication and LDN
  • Potential risks with LDN
  • How LDN can help with autoimmunity, including Graves’ disease and Hashimoto’s
  • How LDN can help with other conditions, including chronic pain and histamine intolerance
  • How long you should take LDN for
  • How to find a doctor who will prescribe LDN

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Here is the transcript for this episode:

Dr. Eric Osansky: Welcome back to the Save my Thyroid podcast. This is Dr. Eric Osansky. In this episode, I am going to discuss low-dose naltrexone and whether it can help people with Graves’ Disease. As I mentioned, if you have Hashimoto’s or a different autoimmune condition, most of this information will also benefit you.

Let’s go ahead and first discuss what is low-dose naltrexone (LDN)? Naltrexone is an FDA-approved medication. In 1985, Dr. Bernard Bihari realized it can modulate the immune system. LDN can benefit autoimmunity, cancer, and other chronic health conditions. The research shows that LDN can act as an anti-inflammatory agent and can potentially help with chronic pain. It can also benefit those dealing with the pain associated with fibromyalgia. It can also be helpful for some people with gastrointestinal disorders or active Crohn’s disease.

When it comes to those with Graves’ and Hashimoto’s, many of these people are taking medication. For those with Graves’, many may be taking antithyroid medication such as methimazole. With Hashimoto’s, people may take thyroid hormone replacement. If LDN is effective in people with Graves’ or Hashimoto’s, in the case of hyperthyroidism, then the person might not need to take antithyroid medication, or they might be able to reduce the dosage.

This is an autoimmune condition. If the immune system is attacking the TSH receptors, which causes excess secretion of thyroid hormone, and someone takes LDN to calm down the immune system, they might not have a need for taking antithyroid medication. So if they are taking 20mg of methimazole a day, maybe they only need to take 10mg instead.

A benefit of LDN is that not everybody does well when taking antithyroid medication. The side effects of LDN aren’t as common. I’ll talk more about those shortly. That’s another thing to keep in mind. A lot of people are unable to take antithyroid medication because of the side effects, not just symptoms, but also antithyroid medication can elevate the liver enzyme or cause a depression of white blood cell count. Usually, we don’t see that with LDN.

As far as people who are taking thyroid hormone replacement, those with hypothyroidism, it’s a similar situation. If someone is taking LDN to calm down their immune system, they very well might not need to take thyroid hormone. Maybe they need a lower dose of thyroid hormone. Those are things to keep in mind if someone is currently taking any type of thyroid hormone medicine and they start taking LDN. They might need to have that medication adjusted by the prescribing doctor.

Let’s talk about potential risk with LDN. One risk here is it doesn’t do anything to address the cause of the problem. If they are taking LDN, and if it’s successfully calming down the immune system, that could have great benefits. But as soon as they stop taking the LDN, chances are the symptoms will come back. For example, in the case of someone with Graves’, if they take LDN, they may have their thyroid under control. But if they stop taking LDN, chances are they would become hyper again.

A big reason why I can’t say LDN should be the first line of treatment for people with Hashimoto’s and Graves’ is because LDN doesn’t always work. In the case of Graves’, one of the main symptoms is an elevated resting heart rate. That can lead to arrythmias. People can go into a thyroid storm with hyperthyroidism.

The problem with LDN is it is hit or miss. That’s what I see with my patients who take LDN. Other practitioners who recommend LDN may see something different. I see that sometimes it works, and sometimes it doesn’t. If someone has a really high resting heart rate, you really want to do what you can to get that heart rate down quickly.

Even if LDN does work, it may take some time. Antithyroid medication typically works quickly. Another option is taking an herbal approach, which is what I did when I dealt with Graves’. I took an herb called bugleweed. Bugleweed doesn’t always work in everybody. When it does work, it works a little bit faster than LDN.

Giving recommendations, I can’t recommend medications to my patients because I’m not a medical doctor, but a lot of my patients are already taking antithyroid medication. If someone is not taking antithyroid medication, I will typically recommend an herb such as bugleweed. LDN is an option, not the first option.

LDN can have a negative effect on sleep. That is something else to consider. That is probably the most common symptom. It doesn’t mean it happens in most people taking LDN. Usually, it’s recommended to take LDN at night, but if someone is having issues sleeping, the prescribing physician will tell the person to take the LDN earlier in the day.

There are times where LDN might cause other symptoms such as headaches. These are not common. In the case of antithyroid medication, that causes symptoms, too. If someone can’t take antithyroid medication, LDN may be a good option because it doesn’t usually cause symptoms. It’s just a matter of will it work or not. Since LDN is not addressing the cause of the problem, if you’re taking any type of medication, you want to do things to improve the health of the immune system, in my opinion. Everything comes down to risk versus benefits when considering whether to take LDN or not.

I know there are some doctors who will give their autoimmune patients LDN. That’s not the first line of treatment in my practice. I can’t prescribe LDN, but I can refer someone to a place where they can get LDN. I don’t take that approach. I want to use other options.

I don’t want LDN to be used as a long-term crutch. Some people do that; they take LDN and stay on it for a very long time. Just like antithyroid medication, you’re not just on it for a few weeks. When someone is on LDN, they will probably be taking it for a few months. But some people will take it for years without addressing the cause of the problem. That is not the approach I want to take in my practice.

Let’s discuss how LDN can help with autoimmunity. How can it help with Graves’ and Hashimoto’s, or other conditions like multiple sclerosis and rheumatoid arthritis? Research shows that LDN modulates the immune system. It accomplishes this by binding to opioid receptors in or on immune system cells. It also affects something called toll-like receptors. Some say it might also help to increase regulatory T-cells. These are necessary to keep autoimmunity in check. That hasn’t really been confirmed as of recording this, but it is also a possibility.

In addition to helping with autoimmunity, LDN can also help with other conditions as well. One of these is histamine intolerance. I’m not going to get into great detail here; that will be a future episode, probably where I interview a guest about histamine. Dr. Leonard Weinstock is a well-known gastroenterologist and an expert when it comes to histamine and Mast Cell Activation Syndrome. Dr. Weinstock theorizes that LDN decreases T-cell activity, and T-cells activate mast cells, which release histamine. He also theorizes that LDN reduces B-cell activity, and this can reduce antibody-stimulated mast cell activity.

I’ve had a number of patients who have histamine problems and have taken LDN. LDN is not going to correct the problem; it won’t address the underlying cause of the histamine intolerance, which almost always relates to the gut. You would want to take LDN while trying to address the cause of the problem.

Also, LDN may help with chronic pain. The research shows that LDN may help to reduce chronic pain in conditions such as fibromyalgia, inflammatory bowel disease (Crohn’s and ulcerative colitis, for example), multiple sclerosis, etc. It seems to help to reduce chronic pain through the modulation of neuroinflammation, specifically the modulation of what’s called glial cells.

LDN can also be used as a prokinetic. Taking a prokinetic can help to prevent a relapse after receiving treatment for SIBO (Small Intestinal Bacterial Overgrowth). Prokinetics help to stimulate the migrating motor complex (MMC). That’s the cleansing wave of the small intestine. Most cases of SIBO are caused by a dysfunctional MMC. It’s important to keep that in mind if you have SIBO.

There are other agents used as prokinetics. There are herbs such as ginger. 5-HTP, there is a product called MotilPro by the company Pure Encapsulations, which can help with that MMC issue. There is an herbal complex called Iberogast, which has eight or nine different herbs that can also help and be really effective. From a prescription standpoint, there is LDN. Low-dose erythromycin is another option. I won’t talk about all the different prokinetics. I just want to mention that LDN can potentially be used as a prokinetic as well.

A few years ago, on my blog, NaturalEndocrineSolutions.com, I interviewed Shannon Garrett, who is a nurse with some other credentials, about LDN. She had a lot of experience with LDN at the time. Shannon personally dealt with thyroid autoimmunity and took LDN. In her experience, it took her nine months to get her body in a healthier state before she started LDN.

According to Shannon, one reason why LDN might not work is because you first need to correct nutrient deficiencies, improve adrenal health, and heal your gut. The problem is this takes time. If someone is starting up with me, that’s what we’re working on. That very well might be one reason why someone might start LDN, and it might not work.

I will say that’s not the case with everyone. There are people who take LDN well before these other imbalances are corrected, and it works. I think it’s hit or miss for other reasons. This might be one reason. I know other practitioners will put their patients on LDN pretty quickly. Many times, even before correcting nutrient deficiencies, improving adrenal and gut health, and correcting other imbalances, the LDN might work. It very well might work better as you address these deficiencies, but that’s not always the case.

At this point, you might have a few questions about LDN. One question you might have is what dosage of LDN should you take if you decide to take it? This really is up to the prescribing doctor. I will say that many doctors will start the patient off with 1.5mg a day. Sometimes even lower than this. Some might start with .5mg per day. It depends on the practitioner. Some of them will keep them on this dosage. If they need it increased, they will increase it. Some practitioners will start the person with 1.5mg a day, and then maybe after the first month, they will increase it to 3mg a day and work their way up to 4.5mg a day. Some will start at 1.5mg and increase it to 2.5mg, 3.5mg, 4.5mg. It really does vary.

Should you take it with food or on an empty stomach? From what I understand, ideally you want to take it on an empty stomach. Again, this is something that you would ask the prescribing doctor. You could also ask a pharmacist.

How long should you take LDN for? Once again, that is something you would want to ask your prescribing doctor.

If you do give it a try, usually you will want to take it for a minimum of three months. Most doctors will say 3-6 months. Some people take it long-term. Let’s say if you have Graves’, and you are taking LDN and it’s working, and you are not able to find the cause of the problem, taking LDN indefinitely is in my opinion better than receiving radioactive iodine or thyroid surgery. Some people will take low dose methimazole, like 2.5mg a day. LDN might be a better option than that if it’s working. As I said, it’s hit or miss. If it’s working, that’s great. As I mentioned numerous times already, even if it’s working, you want to address the cause of the problem.

How can you find a doctor who will prescribe LDN? There are still a lot of medical doctors who are not open to prescribing LDN. There is a good chance if you asked your primary care doctor, they might say no. It depends. If you have an open-minded primary care doctor, they very well might be willing to prescribe it. They might be in the habit of prescribing LDN. That’s still not common, but it doesn’t hurt to ask.

What I would say is if your primary care physician is unwilling to prescribe LDN, you could contact some of the local pharmacists and ask them if they know of local doctors who prescribe LDN. I don’t see why they wouldn’t be able to give you that information. The pharmacies would know because they fill the prescriptions.

There are also websites you can visit like LowDoseNaltrexone.org. You might be able to find some information on practitioners who can prescribe LDN.

There is also a website, LDNDirect.com. You can schedule a remote call with either a medical doctor or a nurse practitioner. They will write you a prescription for LDN.

Another one is LDNDoctor.com. Same thing there. You can schedule a telemedicine call, and the practitioner, as far as I know, I don’t know any situations where they won’t write a prescription for LDN. Of course, you have to discuss it with them.

Very affordable. LDN Direct is around $100 to schedule with their medical doctor. With the nurse practitioner, it’s a little bit less.

There is also a website called LDNScience.org. That does have a directory where you can search for a practitioner who will prescribe LDN. If you absolutely want to see someone in person, you might want to go there. I believe they also have international practitioners, not just those in the United States.

That’s pretty much all I want to discuss when it comes to LDN. I hope you learned a lot. You might want to go back and review this if you are serious about getting LDN. As I mentioned, this isn’t something I recommend to most of my patients. I decided to record this just because a lot of people ask about LDN. I figured I’d put this recording together. I’m sure in the future, I’ll interview other practitioners who have more experience than me when it comes to recommending LDN, even physicians who actually prescribe LDN to their patients. Like I said, I wanted to put this together just because it is a question that I get pretty commonly. I hope you learned a lot of valuable information, and I look forward to catching you in the next episode.