How to use LDN to Treat Hashimoto's Thyroiditis (Dosing, Safety & More)

How to use LDN to Treat Hashimoto’s Thyroiditis (Dosing, Safety & More)

There are very few medications that you can use to treat Hashimoto's thyroiditis and LDN is one of those medicines. 

But how does it work? Will it work for you? Is it safe to use? And, if so, how should you dose it? 

We are going to explore all of these questions and more. 

I've been using LDN for several years with great success and the goal of this article is to share what I've learned through the years so that you can determine if LDN is worth using in your situation. 

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LDN 101

If you aren't familiar with LDN let me fill you in really quickly. 

LDN is a prescription medication which stands for low dose naltrexone. 

It's a prescription medication which is often used off-label to treat the autoimmune disease Hashimoto's thyroiditis

LDN probably works by stimulating the release of endorphins which then impact your immune system and help to balance or regulate autoimmune activity. 

It also seems to have positive effects on other hormone systems such as insulin and can also help reduce inflammation. 

The exact mechanism of action is actually not well understood, so we are not going to focus on it for this discussion. 

The important thing to know here is that LDN is one of the only prescription medications which can be used to treat Hashimoto's.

It would be one thing if LDN was one of many potential options that Hashimoto's patients have at their disposal but this isn't true. 

At the time of this writing, there are zero FDA approved medications for Hashimoto's thyroiditis which means the standard of care (standard treatment option) is to 'wait and see'. 

The 'wait and see' approach (1) involves waiting until your own body destroys a sufficient amount of your thyroid gland that you then require taking thyroid medication. 

wait and see approach for Hashimoto's thyroiditis

LDN serves an important purpose:

To try and reduce the autoimmune destruction on your thyroid gland, to help reduce systemic inflammation (2), to help re-educate your immune system (3), and to help naturally improve thyroid function in your body. 

And, while it is becoming more and more accepted that LDN can potentially help with these things, there are very few clinical studies (if any) which show that LDN is effective specifically for Hashimoto's thyroiditis. 

There are, however, other studies which show that it can be effective in treating OTHER autoimmune diseases such as Crohn's disease (4). 

Drawing from this evidence, it's plausible that LDN can ALSO help with Hashimoto's, even if no such studies exist which prove this claim. 

Indeed, my clinical experience (I've used LDN for many years on many patients) suggest that it can be effective for thyroid patients and for those with Hashimoto's. 

With this in mind, let's talk more about the specifics of using this medicine.

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Will LDN Help Reduce Thyroid Antibodies?

Because Hashimoto's is an autoimmune disease and because it is felt that the antibodies in these types of diseases do damage to the body, people often pay very close attention to their absolute antibody level. 

What they don't always appreciate, though, is that the severity of autoimmune disease (especially for Hashimoto's) doesn't always correlate with these antibody levels. 

Does that mean that you should ignore your antibody levels? 

No, but it does mean that you shouldn't judge whether or not LDN is working based off of these levels. 

If you are new to Hashimoto's, the antibodies we are talking about are called TPO antibodies (thyroid peroxidase antibodies) and TgAB (thyroglobulin antibodies) and these are the antibodies which your immune system creates which cause problems for your thyroid. 

Both of these antibody levels can be measured in the serum and tracked and the presence of these antibodies (if also combined with abnormal thyroid lab tests or hypothyroid symptoms) can help make the diagnosis of Hashimoto's thyroiditis. 

The point I am trying to make here is this:

It's possible for you to use LDN and for it to be effective without it also lowering your antibody levels. 

I still think it's a good idea for you to continually check your antibodies as a way to monitor your lab tests and your progress, but don't use your antibodies as a metric as to whether or not the medication is working. 

You may find that as you take LDN your antibody levels decrease and you feel markedly better. 

Some people may find, however, that their antibody levels stay the same or increase and yet their symptoms have improved dramatically. 

The medication is probably still working in both scenarios but through different mechanisms. 

How to Dose LDN

LDN is called low dose naltrexone for a reason and that reason has to do with how it is dosed. 

The "standard" doses for Naltrexone are typically as high as 50mg per day. 

In addition, the standard tablets come in 50mg doses (5). 

But when we are talking about LDN we are talking about much lower doses than this. 

Typical doses for LDN range from 1.5mg to 4.5mg per day which is about 11 to 33 times lower than these standard doses. 

Because of this, you will most likely need to get your LDN compounded from a compounding pharmacy. 

It's possible to use the standard 50mg tablets, but it's not easy to try and break those tablets up to the small doses that are necessary.  

There are many ways to dose LDN, but I will give you what I think works bests:

  • Start with 1.5mg per day for 15 to 30 days
  • After 15-30 days increase up to 3.0mg only if you are not experiencing negative side effects and if you have not noticed a positive improvement
  • After another 15-30 days (depending on sensitivity), increase up to 4.5mg per day (but only if you are not experiencing any negative side effects or the desired positive outcome)

This slow titration schedule allows you to slowly increase your dose over a period of time while reducing the chance of negative side effects. 

*Note: there are many other ways to dose LDN and I am just sharing what I believe is the most effective based on my own experience. You might, however, find that some doctors start you right away at 4.5mg or accelerate the titration schedule. 

Side Effects of LDN

Like any medication, LDN can have both positive and negative side effects. 

I find that most people who use LDN experience either positive side effects (the things you want to happen) or simply no reaction at all (which is better than having a negative reaction). 

Having said that, though, there are some people who do experience side effects which would be considered 'negative' even though they are typically rare. 

The most common side effect that I see is insomnia, which can be solved by changing the time of day that you take the medication. 

Some people also experience changes in their dreams (especially if they take it at night). For the most part, these are not necessarily negative but they can be. 

Rarely, I also see some people suffer from nausea and headaches (but these are quite uncommon). 

Further potential side effects of LDN (both good and bad) include:

  • Improved sleep
  • Insomnia (it can either help or harm your sleep)
  • Weight loss
  • Reduction in inflammation
  • Reduced joint pain (6)
  • Improved blood sugar
  • Nausea
  • Headaches
  • Vivid dreams

Compared to most medications, this list is actually quite mild. 

Don't let the potential side effects of using LDN stop you because most people do very well when taking it. 

Studies also confirm that this medication is quite safe and well tolerated (7). 

What to Expect when Using LDN

Will using LDN be a slam dunk for you and your Hashimoto's?

The answer is maybe, but you shouldn't walk into therapy expecting this medication to be a miracle drug or something that will completely turn around your disease state. 

While it is true that this sometimes happens, it's been my experience that this type of response is actually quite rare. 

Perhaps 2-5% of people who use LDN will see a vast improvement in their symptoms over a short period of time. 

Then there is another 40-60% or so who will see definite improvement but this improvement will be gradual and appear in slowly over a several month period. 

Then there is another large group, perhaps close to 40%, who will not experience any noticeable improvement in their symptoms at all. 

percentage of people who improve on LDN

(Image: this image is from a small study done on patients with fibromyalgia and not Hashimoto's so the percentages do not reflect what I see in my own clinical practice)

This group of people, for whatever reason, may not be responding to the LDN at all. 

If you fit into this category then it may be worth it to adjust your dosing and the time of day that you take the medication. 

These small steps might actually make a big difference and should be explored before you discontinue it altogether. 

There is also another group of people (percentage unknown but perhaps close to 20%) who do not believe LDN is working in their body but notice an abrupt worsening in their symptoms once they stop taking the medication. 

Consider this as a warning before you discontinue using LDN. 

How to Get LDN

While there are PLENTY of benefits to using LDN, it can actually be somewhat hard to get, but certainly not impossible. 

So, how do you get it?

In order to obtain LDN, you MUST get a valid prescription from a doctor. 

But, because LDN is not FDA approved for treating Hashimoto's, it can actually be somewhat difficult to get from regular doctors. 

Doctors including endocrinologists, family practice doctors, and other conventionally trained physicians are often not too keen on writing a prescription for you, even when faced with evidence in the form of clinical studies

natural thyroid supplements version 2

If you work with your doctor and bring in the clinical studies which show that this medication can be effective, then you run a higher chance of getting a prescription. 

Remember, though:

Do not argue with your doctor or become angry or frustrated. This response will almost always result in even more push back from your current doctor. 

If you can't find a conventionally trained doctor who will prescribe it for you then you may have to look into alternative or integrative doctors. 

These doctors are much more open to using medications such as LDN. 

You can find them by searching for doctors who specialize in integrative medicine, functional medicine, and anti-aging medicine. 

You might also find success using Naturopaths but only if they can prescribe in your state (I believe there are about 22+ states which allow them to prescribe medications (8) at this time but feel free to correct me and provide more accurate info in the comment section). 

I have a list of tips and tricks that can help you find a doctor to help with your thyroid here. 

Other Uses for LDN

LDN is also one of my personal favorite medications to use for those with thyroid disease because of its effects on metabolism and weight management. 

I find that the majority of hypothyroid patients, which includes those with Hashimoto's, also seem to have trouble losing weight and keeping it off. 

This makes LDN the perfect combination medication in patients who struggle with both problems. 

In fact, I find myself using LDN more for weight management than I do for the autoimmune component of Hashimoto's thyroiditis. 

Regardless of the primary purpose you are using it for, just realize that LDN may have other benefits in your body. 

How does LDN help with weight loss?

It's actually not clear, but it's probably mediated through a combination of its impact on your hypothalamus (the metabolism control center) and its impact on certain fat hormones such as insulin (and perhaps leptin). 

And, what might surprise you further, is that most doctors should know that it does this!

Why?

Because Naltrexone (which is another name for LDN) is one of the two active drugs in a medication known as Contrave (9). 

And this medication is FDA approved for weight loss!

This is important because LDN is not an FDA approved therapy for treating Hashimoto's (remember, no such treatment or medication exists for that purpose) which means if you use it for this purpose you are using it off-label. 

But using Naltrexone for weight loss is considered FDA approved (provided it's used in combination with Wellbutrin which is the other drug in Contrave). 

The dosing of LDN for weight loss and for Hashimoto's do differ, however, so keep that in mind. 

You may not notice the weight loss effects at the smaller doses of LDN which are typically used for treating autoimmune disease. 

But be cautious about increasing your dose too high which can also have negative consequences. 

Conclusion

LDN is a great medication which can potentially help some people who suffer from Hashimoto's thyroiditis. 

While it isn't FDA approved for this purpose, there have been some studies which show that it can help mediate the immune system and help reduce inflammation. 

It's plausible that through these effects it may also have an influence on autoimmune thyroiditis. 

My personal experience suggests that Hashimoto's can be beneficial for approximately 60% of Hashimoto's patients who may experience some degree of improvement while using it. 

If you decide to use it, be sure to watch for side effects and keep an eye on your thyroid lab tests (both your antibodies and thyroid function tests) as they both may fluctuate. 

Now I want to hear from you:

Are you using LDN for your Hashimoto's?

Do you notice an improvement in your symptoms?

How long have you been taking it?

If you are taking it, how did you get your doctor to prescribe it?

Leave your questions or comments below! 

References (Click to Expand)

how to use LDN for Hashimotos thyroiditis
Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

32 thoughts on “How to use LDN to Treat Hashimoto’s Thyroiditis (Dosing, Safety & More)”

  1. Another great article, Dr. Childs. My recent blood work showed all my thyroid labs were ok, except my Reverse T3 was fairly high at 24 and I still feel “out of it” some days like I’m living in slow-motion and experience muscle pain off and on. I’ve been on 30 mg of Armour Thyroid, which drastically improved my debilitating condition before. My doctor prescribed LDN 1.5 mg to help bring down any inflammation and hopefully RT3. She wanted to try that as a first order of treatment prior to raising my T3 dosage. I’ve been taking it for a few days and I can point to a “general feeling of wellness” and not feeling like I am living in slow-motion, if that makes any sense. I’ll report back on my treatment after my next blood work to see if it did reduce the RT3 and help with overall pain. Thank you again for writing about LDN. I had never heard of it prior to reading it in your blogs.

    Reply
  2. In case this can help anyone:

    Happy to report back after 1 month on LDN. TPO Antibodies have come down further and in the single digits. The most important change I have noticed is a marked improvement in body pain and sleep. I am able to get deep sleep, in a way that I haven’t in a long time and wake up feeling refreshed. The body pain at the start of my journey (keto induced hashimotos thyroiditis) was a 7-8 (yes, that bad) is now <1. The brain fog hasn't disappeared a 100%, but my doctor is still working on correcting my estrogen & progesterone balance and hoping that will address it.

    My daily treatment so far: 30 mg Armour Thyroid. 1.5 mg LDN, Zinc 30 mg, Selenium 100 mcg, S acetyl Glutathione 200 mg, Turmeric, Calcium D Glucarate 3000 mg. I am gluten & soy free. I do consume organic dairy – no intolerance.

    Reply
  3. Forgot to add: TSH is 0.68 (about the same), FT3 is 3.8 (improved), RT3 has dropped from 24.8 to 8.0 (markedly improved)

    Reply
  4. BuyLDN by SUKI is advertising that you can LDN order from them directly
    without prescription. Is that legitimate???

    Reply
  5. I have used LDN in the past year. It worked wonders for eliminating all pain. However, after using it for a period of time I begin to have symptoms of muscle cramping. I will try it again and keep it at 1.5 and see what happens. The hardest part about all of this is getting my thyroid med (Tirosint Sol 75) estradiol and testosterone working to get my energy levels to some normal capacity. I had a total hysterectomy and then my thyroid tanked! Thank you for all you do to bring this information to us.

    Reply
  6. Are you using LDN for your Hashimoto’s? Yes, My Doctor prescribed it as you explained above. I started at1.5mg and worked up to 4.5 mg.

    Do you notice an improvement in your symptoms? Yes, another bonus was that I have lost 19 lbs.

    How long have you been taking it? I have been taking LDN for 4 months.

    If you are taking it, how did you get your doctor to prescribe it? My doctor suggested I go on LDN.

    Reply
  7. As a Hashimotos patient that suffered from instant weight gain of 3 kg after every bout of major stress, LDN 4.5 mg was used daily for the past 6 months. It worked extremely well for the first 2-3 months, reversing the instant weight gain of 3kg & regulating the sleep cycle. However after antibiotic treatment with the last UTI, LDN “stopped working” with the weight loss & alcohol intolerance returned. “Stopped working” in this context means weight loss plateaued & appeared to cease. So is LDN’s effectiveness also linked to gut biota/liver dysfunction & other hidden body inflammations like UTI’s also?

    Reply
    • Hi Minime,

      I would say it’s probably more related to the fact that while LDN can help with weight loss it’s not an ultra-powerful weight loss medication. Instead, it’s much more likely that other conditions are contributing to your weight and those issues must be addressed for further weight loss.

      Reply
  8. Great information Dr. Child’s, I have an appointment next week with my endocrinologist. She never validates my symptoms. I’m 44 and her reply is that is due to my age. Any advice as to how to convince her to prescribe LDN?

    Reply
  9. Since I had my thyroid removed in 2014 due to multi-nodule goiter and subsequent Hashimoto diagnosis, would this still be beneficial for me? I can see several areas that it could help, just not sure about it.

    Reply
    • Hi Beverly,

      The answer is almost always “it depends”. In terms of helping with Hashimoto’s, it will obviously be limited due to the fact that most of your thyroid is removed but it also has other effects and benefits outside of its impact on thyroid function. So it really depends on your other symptoms and other conditions.

      Reply
  10. I have a prescription for LDN from my Naturopath . I took it briefly last year and I was then able to open the door to begin losing weight while lowering my TPO antibodies. Problem is it made me slightly nauseous and gave me headaches. I have vertigo so this is bothersome. I am looking to try again. What is the best time of day to take LDN? Is taking with food recommended.?

    Reply
    • Antoinette,

      I now take LDN right before I go to bed, usually about 2-3 hours after dinner. At the beginning, I did take it on an empty stomach in the morning (because I was taking my thyroid meds at night) and I did have really bad nausea lasting till mid morning. Try taking it at before bed and if that doesn’t help, try a different compounding pharmacy, sometimes the fillers create stomach problems that manifest as nausea.

      Reply
  11. Are you using LDN for your Hashimoto’s? Yes, My Doctor prescribed it as above explained. I started at 1.5mg and worked up to 4.5 mg, I am on this medication for almost two years now.
    Do you notice an improvement in your symptoms? Yes, my cold/flu symptoms that frequents are gone for good.
    If you are taking it, how did you get your doctor to prescribe it? I had to convince my doctor to put me on LDN. I used some of your articles that mention it plus some health articles I found on the internet. Unfortunately, in my case, the desirable side effect of weight loss didn’t happen.
    Thanks, for your constant help.

    Reply
  12. I have been following your web site with much interest. Lots of good info.

    Are you using LDN for your Hashimoto’s? Not currently but I have some LDN that I purchased previously and never used. I am going to try adding it to what I currently take.

    If you are taking it, how did you get your doctor to prescribe it? I did not ask my doctor. I purchased over the web from theantiaging.store.

    Would adding LDN allow one to reduce their Armour dosage?

    Reply
  13. Hello,
    I have only been taking LDN for three weeks now. The first two weeks were 1.5 and I’m now up to 3mg. I have noticed the vivid dreams and lack of sleep and also the headaches that seem to have increased since taking the LDN. I haven’t noticed any differences in the joint pain, but would like to give this more time. So given the “side effects” that I’m experiencing I have a few questions…1. Would you recommend that I switch to taking the LDN to the morning along with my Synthroid or should I consider a different time? (I currently take before bed). Question 2. How long does it generally take before I start to notice any benefits? Questions 3. I have also noticed an increase in my mouth with canker sores ( I know that this generally means I’m fighting off illness)…how is this related to the LDN and do I need to just give my body more time to adjust? I won’t be getting my blood work done until after the new year. I’ve been fighting this disease for so many years…I’m frustrated and sometimes lack the patience that I need.
    Any help would be appreciated!
    Thanks,
    Amy

    Reply
  14. Dear Dr. Westin,
    First of all, I’d like to thank you so much. Although you are so very far away from me, I’m from Brazil, you changed my life.
    A brief story about me, I’m 61, 6ft3, and was weighing 310 lb when I first read one of your articles about thyroid and Hashimoto.
    I have Hashimoto and something caught my attention at that time, my doctor for years only checked my TSH and T4 and prescribed me Puran T4. I realized that this is a wait and see approach or something like that.
    I’ve read many articles about LDN therapy and searched for a doctor that knows about it. For my luck, I found a doctor who performed many clinical studies with LDN.
    On my first consult, I had mentioned about other thyroid markers that I’d read on your article “Thyroid Lab Tests (Optimal Ranges vs Normal Ranges & Where you Want your Labs to be)”, and the doctor checked all of them.
    All markers were out of range and also my PCR was very high.
    Not only he started with LDN at 3mg but also prescribed me with a lot of vitamins and minerals: Selenium, Zinc, Copper, Magnesium, Manganese, Boron, Chrome, Potassium, Astaxanthin, L-Glutathione, CoQ10, Vit A, Vit B1 B2 B5 B6 B12(Methylcobalamin), Vit D3, Vit E, Vit K2 Mk7, Cod Liver Oil, Omega 3, Coconut Oil … wow! That’s a lot.
    Also, he started me with a keto diet and intermittent fasting.
    16 months later, now I’m weighing 230lb, 80lb less, markers are OK, not optimal ranges, but OK. My quality of life is way above my expectancies and I thank you for that, you put me in the right path. Thanks again.
    Sincerely yours
    Carlos Carvalho

    Reply
  15. I’m male, 73, 6’/190lbs. I was diagnosed with Hashimoto’s about 20 years ago – I was never tested for antibodies; the diagnosis was based on TSH and T4/T3 levels. I’ve been taking levothyroxin ever since, starting at 175mcg and gradually lowering it to the current 112mcg as TSH stabilized. Now my standard test is of TSH and sometimes free T4. TSH has usually been in normal range (after going too low for a while).

    Suddenly last month (Sept. 2020) TSH jumped 50% to 6.69 (from 4.24 a year ago – my PCP doctor doesn’t believe in frequent testing), though free T4 was 1.43 (range 0.82-1.77). On the results printout my doctor wrote “stable and acceptable.” I don’t know about acceptable but it certainly isn’t stable.

    So after a month on my own I had it tested again – TSH was 6.3; I didn’t test free T4 but for the first time I had myself tested for ATA and TPA – ATA: 1,123.2 (yikes! range 0-0.9); TPA: 43 (range 0-34). Is 1,123 ATA even possible?

    I’ve been taking 450mg of SR Wellbutrin for about 20 years and it works well on depression. I’ve still gained about 10+ pounds partly because of lack of exercise (don’t feel motivated, partly due to arthritis pains everywhere) and not cutting down on calories. In the last month I’ve replaced my usual dinner with a protein drink I have every morning and some yogurt, and still managed to lose only 5 pounds at most. (I surfed and cycled for 40 years, then began walking for miles, so I’ve always had excellent lung/heart capacity, but now my lungs are working at about 75% of expected and I’m out of breath climbing stairs, though not while walking on flat surfaces.)

    My questions: is it too late for LDN to do any good? Also, I need my immune system because I’ve had low-grade prostate cancer for 12 years (and of course covid is out there too), so I’m concerned about suppressing my immune system. I do get flu, pneumonia, and shingles vaccines. Should I be seeing an endocrinologist? Many thanks for any insight.

    Reply
  16. I have been taking LDN for a month now. I’m at 1.5 mg right now and will slowly titrate up. This has already been life changing for me! I was at the point of feeling very hopeless when my endocrinologist suggested I take it. It’s been a total game changer. Even though there is room for improvement which I’m confident will happen with more time, I’m functioning again!
    My side effects have been tolerable. I have had some headaches and a little insomnia. But it’s relieving my constant debilitating fatigue and body aches. Thanks for this great article!

    Reply

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