Naltrexone for Hashimoto's Thyroiditis
Naltrexone is not effective for treating Hashimoto's thyroiditis and should not be used for this indication. The available evidence shows no benefit in reducing thyroid hormone requirements or modifying the autoimmune disease process.
Evidence Against Naltrexone Use in Hashimoto's
Direct Evidence from Hypothyroidism Studies
A quasi-experimental before-after study of 898 patients with hypothyroidism found no association between starting low-dose naltrexone (LDN) and subsequent changes in thyroid hormone dispensing 1
If anything, there was a tendency toward increasing levothyroxine consumption with increasing LDN exposure, suggesting no therapeutic benefit and possibly worsening thyroid function 1
The study authors explicitly concluded that results do not support claims of efficacy of LDN in hypothyroidism 1
Lack of Supporting Evidence
A comprehensive scoping review of LDN's therapeutic uses across multiple conditions did not identify Hashimoto's thyroiditis or autoimmune thyroid disease as conditions with meaningful evidence of efficacy 2
Guideline evidence for naltrexone use is limited to Crohn's disease (where it showed minimal benefit), opioid-induced constipation, and alcohol use disorder—none of which are relevant to thyroid autoimmunity 3
Standard Treatment Remains Thyroid Hormone Replacement
Established Management Approach
Hashimoto's thyroiditis is characterized by thyroid-specific autoantibodies and lymphocytic infiltration, leading to primary hypothyroidism 4
The mainstream treatment is based on management of hypothyroidism with substitution therapy using levothyroxine or triiodothyronine 4
Thyroid hormone replacement addresses the clinical manifestations of the disease and should be carefully titrated, as some patients may have autonomous thyroid function from thyroid-stimulating antibodies despite hypothyroidism 5
Clinical Pitfalls to Avoid
Do not delay or substitute standard thyroid hormone replacement therapy with unproven treatments like naltrexone, as this could result in persistent hypothyroidism and its associated morbidity 4
Be aware that patients may seek LDN based on anecdotal reports or online claims, but the objective evidence from prescription database analysis contradicts these claims 1
Monitor thyroid function tests regularly and adjust levothyroxine dosing based on TSH levels rather than pursuing immunomodulatory therapies without evidence 4, 5