From the Guidelines
Naltrexone is not an effective treatment for hypothyroidism, and the principal treatment for hypothyroidism is oral T4 monotherapy (levothyroxine sodium) 1. Hypothyroidism is typically treated with thyroid hormone replacement therapy, most commonly levothyroxine, which replaces the thyroid hormone your body cannot produce in sufficient quantities. The standard starting dose for adults is typically 1.6 mcg/kg body weight daily, taken on an empty stomach 30-60 minutes before breakfast. While low-dose naltrexone (LDN) has been explored experimentally for some autoimmune conditions including Hashimoto's thyroiditis (which can cause hypothyroidism), it is not FDA-approved for this purpose and lacks robust clinical evidence supporting its use for thyroid disorders. Key points to consider when treating hypothyroidism include:
- Regular blood tests to monitor and adjust medication as needed
- Working with your healthcare provider to establish the correct levothyroxine dosage based on your TSH levels
- The importance of treating hypothyroidism to improve important health outcomes, such as cardiovascular- and cancer-related morbidity and mortality, as well as falls, fractures, functional status, and quality of life 1. In the context of real-life clinical medicine, it is essential to prioritize treatments with established efficacy and safety profiles, such as levothyroxine, over experimental or unproven therapies like naltrexone for hypothyroidism.
From the Research
Naltrexone for Treating Hypothyroidism
- There is no evidence to suggest that Naltrexone, an opioid receptor antagonist, is effective for treating hypothyroidism 2.
- A quasi-experimental before-after study found no association between starting low-dose naltrexone (LDN) and changes in the dispensing of thyroid hormones to patients with hypothyroidism 2.
- The study results do not support claims of efficacy of LDN in hypothyroidism, and if anything, there was a tendency towards increasing levothyroxine (LT4) consumption with increasing LDN exposure 2.
Standard Treatment for Hypothyroidism
- The standard treatment for hypothyroidism is levothyroxine (LT4) replacement therapy, which aims to normalize signs and symptoms, as well as achieve thyroid-stimulating hormone (TSH) concentrations within the reference range 3, 4, 5, 6.
- Adding triiodothyronine (T3) to LT4 is not recommended, even in patients with persistent symptoms and normal levels of TSH, unless in specific cases where combination therapy may be warranted 4, 5, 6.
Combination Therapy
- Combination therapy with LT4 and T3 may be considered for patients with confirmed overt hypothyroidism and persistent symptoms who have had adequate treatment with LT4 and in whom other comorbidities have been excluded 5.
- However, the decision to start treatment with T3 should be a shared decision between patient and clinician, and individual clinicians should not feel obliged to start T3 or continue T3 medication if they judge it not to be in the patient's best interest 5.