Written by the Nuvirox Research Team
Key Points
- Hashimoto’s thyroiditis involves measurable oxidative stress and a documented drop in SIRT1, an NAD+-dependent enzyme, inside thyroid cells.
- No published human trial has tested NAD+ precursors like nicotinamide riboside (NR) specifically in people with Hashimoto’s.
- The evidence is mechanistic and preclinical, not clinical — a real research lead, not a proven treatment.
Short answer: there’s a documented cellular link between low SIRT1 activity and Hashimoto’s thyroiditis, but no human trial has actually tested NAD+ precursors in people with the condition. If you searched this because you’re managing Hashimoto’s and wondering whether an NAD+ supplement could help alongside your thyroid medication, the honest answer is that the biology is plausible and actively studied, but the direct evidence isn’t there yet. This is one of those topics where it matters more than usual to separate the mechanism from the marketing.
What is actually happening in the thyroid in Hashimoto’s?
Hashimoto’s thyroiditis is an autoimmune condition where the immune system gradually attacks thyroid tissue, most often eventually causing hypothyroidism. Part of that damage is driven by oxidative stress: an imbalance between reactive oxygen species generated by immune activity and the antioxidant systems that are supposed to clean them up.
A 2021 study in the International Journal of Molecular Sciences looked directly at this in human thyroid cells. Researchers found that when thyrocytes were exposed to the inflammatory signals typical of Hashimoto’s, SIRT1 protein expression dropped significantly, alongside reductions in antioxidant enzymes like catalase and superoxide dismutase. The same pattern showed up in thyroid tissue samples taken from actual Hashimoto’s patients, not just cell cultures.
Why does SIRT1 matter, and what does NAD+ have to do with it?
SIRT1 is one of seven human sirtuins, a family of enzymes that depend entirely on NAD+ to function — no NAD+, no sirtuin activity, regardless of how much SIRT1 protein is present. Sirtuins in general help regulate inflammation, oxidative stress response, and mitochondrial upkeep. That’s the chain of logic behind interest in NAD+ precursors here: if SIRT1 activity is already suppressed in Hashimoto’s thyroid tissue, and SIRT1 needs NAD+ as fuel, then raising cellular NAD+ might, in theory, help restore some of that lost sirtuin function.
It's a coherent hypothesis. It is not the same as evidence that taking an NAD+ precursor actually changes thyroid antibody levels, TSH, or symptoms in a real person with Hashimoto’s. That gap between plausible mechanism and demonstrated outcome is exactly where a lot of supplement marketing gets ahead of the science.
What human studies actually show
Hepp et al. 2021, International Journal of Molecular Sciences — human thyrocyte and tissue study. This is the most directly relevant paper. Researchers incubated primary human thyroid cells with Th1 cytokines to mimic the autoimmune environment of Hashimoto’s, then measured NOX4, SIRT1, HIF-1α, and antioxidant protein levels. Th1 cytokine exposure significantly reduced SIRT1 expression and antioxidant enzymes while increasing markers of oxidative stress. The same SIRT1 downregulation was confirmed in thyroid tissue biopsies from actual Hashimoto’s patients compared to controls. This tells us the SIRT1 pathway is genuinely disrupted in human Hashimoto’s tissue — but the study did not administer NR, NMN, or any NAD+ precursor to anyone. It measured a broken pathway; it did not test a fix.
The honest counterweight: no supplementation trial exists. A search of the published literature turns up no randomized, placebo-controlled trial of nicotinamide riboside, NMN, or any NAD+ precursor conducted specifically in Hashimoto’s thyroiditis patients. What does exist is general human safety and NAD+-elevation data: an 8-week trial found that 100–1000 mg NR doses dose-dependently raised whole-blood NAD+ by 22–142% in healthy adults with no increase in adverse events (Conze D, Brenner C, Kruger CL. Safety and metabolism of long-term administration of NIAGEN (nicotinamide riboside chloride) in a randomized, double-blind, placebo-controlled clinical trial of healthy overweight adults. Sci Rep. 2019;9:9772. doi:10.1038/s41598-019-46120-z). A separate 6-week crossover trial confirmed NR is well tolerated in middle-aged and older adults (Martens CR, Denman BA, Mazzo MR, et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018;9(1):1286. doi:10.1038/s41467-018-03421-7). Neither trial enrolled anyone with autoimmune thyroid disease, and neither measured thyroid antibodies or TSH.
A broader honest caveat. Even in populations where NAD+ precursors have been tested more extensively, results are mixed. A 21-day trial in older adults found NR raised the NAD+ metabolome in skeletal muscle without measurably improving mitochondrial bioenergetics (Elhassan YS, Kluckova K, Fletcher RS, et al. Nicotinamide riboside augments the aged human skeletal muscle NAD+ metabolome and induces transcriptomic and anti-inflammatory signatures. Cell Rep. 2019;28(7):1717-1728. doi:10.1016/j.celrep.2019.07.043. PMID: 31412242), and a 2025 randomized trial in long-COVID patients — a population with its own documented inflammatory and mitochondrial burden — found no significant difference in fatigue severity between NR and placebo groups after 10–20 weeks (Wu CY, Reynolds WC, Abril I, et al. Effects of nicotinamide riboside on NAD+ levels, cognition, and symptom recovery in long-COVID: a randomized controlled trial. eClinicalMedicine. 2025;89:103633. doi:10.1016/j.eclinm.2025.103633. PMID: 41357333). Raising NAD+ does not automatically translate into a felt clinical benefit, even in conditions with a plausible mitochondrial or inflammatory basis.
What NAD+ Restore won't do
NAD+ Restore is not a treatment for Hashimoto’s thyroiditis and will not lower thyroid antibodies, restore thyroid hormone production, or replace levothyroxine or any other prescribed thyroid medication. It does not diagnose or manage hypothyroidism. If you have persistent fatigue, brain fog, weight changes, or cold intolerance and haven’t had your thyroid checked, that’s a conversation for a doctor and a blood panel (TSH, free T4, and thyroid antibodies), not a supplement decision.
See a doctor if you have a new lump in your neck, difficulty swallowing, a resting heart rate that feels persistently fast or slow, or if your energy or mood symptoms are worsening despite being on thyroid medication — dose adjustments, not supplements, are usually the right next step there.
Dosing and realistic timelines
The human trials referenced above used 100–1000 mg of nicotinamide riboside daily, most commonly in the 300–500 mg range, typically for 6–12 weeks before NAD+ metabolome changes were assessed. NAD+ Restore provides 500 mg of NR per 2-capsule serving, consistent with the range studied for safety and NAD+ elevation — not a Hashimoto’s-specific protocol, because none exists. If you take levothyroxine, take it on an empty stomach as directed and separate any other supplement, including this one, by at least four hours to avoid absorption interference; this is a standard levothyroxine precaution, not something specific to NR.
Frequently asked questions
Can NAD+ supplements lower my thyroid antibodies?
There’s no published trial showing this. The SIRT1 research explains why the idea is biologically plausible, but plausibility isn’t proof, and antibody levels haven’t been tested against NAD+ precursor supplementation in any published study we could verify.
Is NAD+ safe to take alongside levothyroxine?
The available human safety data for NR doesn’t flag a specific interaction with levothyroxine, but as a general rule, separate any capsule supplement from your thyroid medication by several hours and mention any new supplement to your prescriber.
Why does Hashimoto’s cause fatigue in the first place?
Fatigue in Hashimoto’s is mostly driven by low thyroid hormone slowing metabolism, though the chronic low-grade inflammation and oxidative stress described above may also play a contributing role that isn’t fully separable from the hormone effect.
Should I get tested before trying anything?
Yes. TSH, free T4, and thyroid peroxidase (TPO) antibody testing is inexpensive and is the only way to actually know whether Hashimoto’s is driving your symptoms versus something else entirely.
A note before considering any supplement: Hashimoto’s is diagnosed and managed through thyroid antibody testing and, when needed, levothyroxine. No supplement replaces that. If you have diagnosed Hashimoto’s or suspect it, work with an endocrinologist before adding any new supplement, since thyroid dosing and absorption can be sensitive to timing with other pills.
From Nuvirox
Why we formulated NAD+ Restore
Each 2-capsule serving delivers 500 mg nicotinamide riboside chloride (NR) — one of the two most-researched NAD+ precursors, within the dose range used in published human trials — alongside 150 mg trans-resveratrol and 50 mg quercetin, polyphenols studied alongside NAD+ pathways for cellular health support, plus 10 mg fenugreek-derived galactomannans to support absorption.
Backed by a 60-day money-back guarantee — long enough to actually evaluate it the way the research says you should.
Learn more about NAD+ Restore →The bottom line
The SIRT1 research gives Hashimoto’s a genuine, cellular-level reason to be curious about NAD+ biology — this isn’t a stretch of unrelated science. But curiosity is where the evidence currently stops. No trial has given an NAD+ precursor to people with Hashimoto’s and measured whether it changes antibodies, thyroid function, or symptoms. Anyone managing this condition should keep their endocrinologist and lab work in the driver’s seat, and treat an NAD+ precursor as, at most, a general cellular-health add-on rather than anything targeted at the autoimmune process itself.
References
- Hepp M, Werion A, De Greef A, et al. Oxidative stress-induced Sirtuin1 downregulation correlates to HIF-1α, GLUT-1, and VEGF-A upregulation in Th1 autoimmune Hashimoto's thyroiditis. Int J Mol Sci. 2021;22(8):3806. doi:10.3390/ijms22083806. PMID: 33917849
- Conze D, Brenner C, Kruger CL. Safety and metabolism of long-term administration of NIAGEN (nicotinamide riboside chloride) in a randomized, double-blind, placebo-controlled clinical trial of healthy overweight adults. Sci Rep. 2019;9:9772. doi:10.1038/s41598-019-46120-z
- Martens CR, Denman BA, Mazzo MR, et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018;9(1):1286. doi:10.1038/s41467-018-03421-7
- Elhassan YS, Kluckova K, Fletcher RS, et al. Nicotinamide riboside augments the aged human skeletal muscle NAD+ metabolome and induces transcriptomic and anti-inflammatory signatures. Cell Rep. 2019;28(7):1717-1728. doi:10.1016/j.celrep.2019.07.043. PMID: 31412242
- Wu CY, Reynolds WC, Abril I, et al. Effects of nicotinamide riboside on NAD+ levels, cognition, and symptom recovery in long-COVID: a randomized controlled trial. eClinicalMedicine. 2025;89:103633. doi:10.1016/j.eclinm.2025.103633. PMID: 41357333
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This article is for informational purposes only and is not a substitute for professional medical advice.