Some days, I just want to bang my head on my desk at work.
A couple of months ago, I diagnosed a young woman with Hashimoto’s thyroiditis. As her TSH (thyroid stimulating hormone) was fairly high and, being an ultra-Orthodox Jewish woman, she wasn’t taking any birth control*, so I prescribed her levothyroxine (L-T4) or what you call Synthroid in the US. Synthroid is a synthetic hormone identical to the one the thyroid makes, or in her case, the one her thyroid wasn’t making enough of. As maternal hypothyroidism can have adverse neurodevelopmental effects on the fetus and may also be associated with an increased rate of miscarriage, in the case of a woman who could get pregnant at any time, prompt treatment was especially important.
Hashimoto’s is very common in young women, and I find myself going through this particular routine several times a year.
She recently returned to my office for another matter, and as I opened her electronic file on my computer, up popped a reminder “retest thyroid function May 2008”. So I asked her how she was feeling on the Synthroid. Her response? “Oh doctor, I wanted to talk with you about that. See, my husband** thought Synthroid wasn’t natural enough, so we went to a naturopath and she gave us something better.”
The “something better” turned out to be Bovine thyroid extract. With the active hormones removed.
Quite a few of my patients are enamored with the idea of taking “natural” medicines. They prefer “natural” vitamin supplements, “natural” iron during their pregnancy, and the like, in the erroneous belief that if it comes from an animal or an herb vs. made in a lab, it must be better. Usually, I’m pretty open-minded about this stuff…if a woman’s hemoglobin is improved by “natural” iron, I have no problem with her taking it as opposed to what she can buy in our clinic’s pharmacy. I don’t have any profit motive to push either pill, and as I tell my patients, I never argue with success.
I could probably live very well wither her decision if she’d elected to start taking, say, Armour Thyroid, which actually contains thyroid hormones. Except that a) I don’t think they have it here, and b) it’s made out of pig thyroids. For a very religious Jewish woman, this would be unacceptable.
But is it really more natural to ingest the thyroid of another animal, than to take a substance which, although synthesized in a lab, is in fact identical to what humans make naturally in their own bodies? I mean, the original treatment for ‘myxedema’ (severe hypothyroidism) in the late 19th century was injections of human cadaveric thyroid extract (complete with the as-yet undiscovered hormones). Since when is cow thyroid more natural for humans than human thyroid??
I explained all this to my patient, but she was still reluctant to take the “unnatural” replica of human thyroid hormone, and asked to retake the thyroid function tests in order to see if the hormone-less cow extract was working. I’m still waiting on the results.
*It’s not really true that ultra-Orthodox Jewish women don’t use any birth control. They do, however, get permission from their Rabbi to do so, who will usually allow it if the woman has had at least one son and one daughter, a very difficult previous birth or very closely-spaced births.
**I don’t believe for one minute her husband was telling her what to do. Jewish women don’t do the “submissive to hubby” bit very well 🙂 .