“Natural”…not always what you think.

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 🙂 .

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7 Responses

  1. I am learning a lot about Jewish beliefs from your blog. I had no idea Orthodox Jews didn’t use birth control.

    Yes, the natural is better thing bugs the crap out of me too. Especially when the treatment is not going to work. I get afraid when folks I know who have cancer start talking about “Natural treatments and diet changes.” I would perfer they take a trip to Dana Farber first.

  2. As I pointed out in the footnotes, it isn’t strictly true that the ultra-Orthodox (that is the demographic I deal with almost exclusively right now, and that this doesn’t necessarily fly for Modern Orthodox Jews like me) don’t use birth control. I was absolutely floored by that fact when I did my first OB-GYN rotation as a medical student in Jerusalem. Even so, the birth rate of this demogaphic is very high – I have patients who are in their early 30s and have 10+ kids. One is currently pregnant with #13 IIRC…

    The Rabbi’s permission to temporarily defer further pregnancies is often contingent upon whether the mitzvah of “Be fruitful and multiply” (construed as at least 1 boy and 1 girl) has already been fulfilled by the couple, and the type of BC used – sterilization, especially vasectomy, is out, as are barrier methods, due to the injunction against spilling sperm for naught. Consequently, the most common methods of birth control – I think this is a general Israeli trend, not only a religious one, because this is already Jewish law proper – are the pill (and now the patch and the NuvaRing as well), IUD’s, and spermicidal foams or sponges.

  3. Actually, Esther, I DO see a great many ultra-Orthodox, and even “ordinary” Orthodox women who eschew all forms of birth control [and the laws of family purity assist conception, as you know] these days. It’s all part of the “search for stringencies” contest.

    Probably not her husband, but very possibly her rav. Especially in the “born-again” [hozrei teshuva] communities, some of whom have charismatic rabbis who hold some weird views.

    I see the “natural” search very often in our ultra-Orthodox patients in fertility treatment, who, by the time they reach us, have been to all kinds of wonder-working rabbis and mystical “fertility improving” procedures. In that respect I can tell them that some of the drugs are actually extracted from human urine–I just don’t tell them that it is often nuns’ urine that is used.

  4. This particular woman isn’t a chozeret bitshuva, and yes, I’ve had women who’ve ‘blamed’ the rav. This woman didn’t, which is why I suspect the real source of the ‘advice’ is one of her neighbors or her MIL.

    And yeah, there are definitely some women who won’t use BC no matter what, among the modern orthodox as well. I agree that “competitive stringency” of Jewish practice plays a large part in this. My (quite religious but not crazy religious) grandfather used to quote Ecclesiastes in this regard:אל תהי צדיק הרבה, or in English “Don’t be too righteous”.

    Speaking of ‘wonder-working’ rabbis, people can do whatever they want. I have pretty serious issues, however, with the people who come to my office demanding Clomid or other meds because the Rabbi “prescribed” it to them.

    I also have equal issues with a certain Jerusalem Rabbi (a Breslaver, who else?) who’s advised some of my older patients they don’t need to have mammographies or, in one case, suggested a young woman with very severe Graves’ disease (on 600mg/day of PTU was still very hyperthyroid) and recurrent abortions stop all her meds and take some herbal tincture. It took a good deal of convincing by myself, her MIL and her fertility doc (who is herself an ultra-Orthodox woman) to get her to start treating herself properly, in this case by getting a total thyroidectomy and going on Synthroid. Her dying of high-output heart failure in a few years wouldn’t have been very pretty…

  5. I always remember, when I read these sort of things, the study they did in California back in the 90s where they had people vote on what pesticide to use on crops outside the town, since there was complaints about the chemical they were using (dunno what it was, but it was FDA approved and all). They offered an alternative– something derived from chrysanthemums. Overwhelming support for the alternative. Despite the fact that it was widely reported to be WAY more toxic and possibly carcinogenic.

    But it’s NATURAL cancer!

  6. Hi, I am the same Amanda that posts over on Dr. Amy’s site; I found this blog through there. I’ve really been enjoying your take on these “hot button” parenting issues.

    I have a question to ask that relates to this post, I hope you don’t mind. I was just diagnosed with low thyroid function and prescribed .05mg Synthroid daily. I got tested for thyroid function because of weight gain, inability to lose weight with diet/exercise, and extreme fatigue. When I google Synthroid, I come across so many message boards with people swearing that Synthroid has caused them to gain massive amounts of weight. Has that been the case with your patients? I don’t know if it is another case of people mistaking one thing for another (i.e. appetite increased, they ate more without realizing it, so they think it must be the Synthroid that caused the gain), or if there is some basis for their claims.

    It is very confusing because I have read the information that comes with the drug and it mentions weight loss as a possible side effect, but makes no mention of weight gain.

  7. Hi and welcome, Amanda 🙂

    I think the weight gain can be attributed to an insufficient dose of Synthroid, not the medicine itself, or as you said – their appetite increase was out of proportion to their actual metabolic needs. In fact, Synthroid is an (illegal AFAIK) ingredient in diet pills – because it can make you lose weight by stepping up your metabolism.

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