From the Guidelines
Naloxone is not recommended for treating hypothyroidism. Hypothyroidism requires thyroid hormone replacement therapy, typically with levothyroxine (T4) at doses starting from 25-50 mcg daily for elderly or cardiac patients, or 1.6 mcg/kg/day for most adults, adjusted based on TSH levels every 6-8 weeks until stabilized 1. Naloxone is an opioid antagonist used to reverse opioid overdoses and has no role in thyroid hormone regulation. The appropriate treatment for hypothyroidism addresses the underlying deficiency of thyroid hormones by providing synthetic versions that restore normal metabolism.
Key Considerations
- Levothyroxine should be taken on an empty stomach, 30-60 minutes before breakfast or 3-4 hours after the last meal of the day, and separated from medications or supplements containing calcium, iron, or aluminum by at least 4 hours.
- Treatment is typically lifelong for permanent hypothyroidism, with periodic monitoring of thyroid function tests to ensure optimal dosing.
- The principal treatment for hypothyroidism is oral T4 monotherapy (levothyroxine sodium) 1.
- Hyperthyroidism is treated with antithyroid medications (such as methimazole) or nonreversible thyroid ablation therapy (for example, radioactive iodine or surgery) 1.
- Although detection and treatment of abnormal TSH levels (with or without abnormal T4 levels) in asymptomatic persons is common practice, evidence that this clinical approach improves important health outcomes is lacking 1.
From the Research
Treatment of Hypothyroidism
- The standard treatment for hypothyroidism is levothyroxine replacement therapy, as stated in 2, 3, 4, 5.
- Levothyroxine is used to normalize thyroid-stimulating hormone levels and relieve symptoms, with the goal of achieving a physiological ratio of free triiodothyronine/free thyroxine (FT3/FT4) and non-suppression of TSH 4.
- Some patients may benefit from the use of liothyronine (LT3) added to levothyroxine, especially if polymorphism of the deiodinase 2 (D2) genes is documented, but more clinical studies are needed to identify these patients 4.
Use of Naloxone (Narcan) in Hypothyroidism
- There is no evidence to suggest that naloxone (Narcan) is used to treat hypothyroidism, as none of the studies mentioned its use in the treatment of this condition.
- The studies discussed the use of levothyroxine, liothyronine, and other treatments for hypothyroidism, but did not mention naloxone 2, 3, 4, 5.
- A related study on low dose naltrexone (LDN) found no association between starting LDN and changes in the dispensing of thyroid hormones, but this is not directly related to naloxone 6.