Current Diagnosis and Treatment of Hypothyroidism are Both Fundamentally Flawed

I have recently been given a new paper written by Professor Rudolf Hoermann, Mel Rowe and Peter Warmingham. The three authors have joined forces to produce to try and improve patients’ knowledge of effective diagnosis and treatment of hypothyroidism. 

The title of their paper is, “A Patient’s Guide to the Diagnosis and Treatment of Hypothyroidism”. I will provide a link to it at the end.

When I was sent the paper by one of the authors. I read it and responded immediately with:
‘It is a brief, simply-explained, to-the-point and altogether excellent paper”.

The paper is extremely worth reading and may help many thyroid patients in discussions with doctors or endocrinologists. Of course, sometimes, the doctor you may be speaking with may be very certain of their point of view. They may not even realise that what they have been taught was only introduced post-1985 when the TSH assay was created. These post-1985 views that are currently being used by most doctors and endocrinologists have now been shown to be very flawed, and this new paper by the three authors points this out very clearly.

The paper points out several major FLAWS in current diagnosis and treatment. I will pick out the major ones listed in the paper, all of which have now been refuted by extensive scientific evidence. The flawed views are:

1. A subnormal assessment of free T4 (FT4) serves to establish a diagnosis of hypothyroidism. Also, TSH is exquisitely sensitive to minor changes in FT4, leading to the adoption of TSH as “the single best screening test for primary thyroid dysfunction for the vast majority of outpatient clinical situations.”

2. T4 is converted to T3 as needed, leading to treatment being changed to levothyroxine (T4) only.

3. TSH within its reference range represents euthyroidism (normal), leading to the treatment dosage of T4 being adjusted to return TSH within its normal range.

All three of the above assumptions are fundamental to current guidelines for doctors and endocrinologists. They need to be replaced with new guidelines that fit the science and help far more thyroid patients fully recover.

We know TSH does NOT correlate to symptomatic improvement and that low TSH does not mean someone is overtly hyperthyroid.

TSH should not be the predominant means of whether a patient is hypothyroid or not, especially when TSH is not overtly high. Both FT3 and FT4 need to be used in the determination of whether a patient is hypothyroid or not.

We now know that improvement in serum FT3 concentrations correlates to symptomatic improvement. We also know that conversion from T4 to T3 does not always work well. Only the T3 hormone provides genomic effect in the cells of the body.

We also know that the clinical presentation of the patient and symptom improvement should be at the forefront of treatment and that any lab assessment of thyroid hormones must include FT3 as well as TSH, FT4 and possibly Reverse T3.

The paper supports all of the statements with research references.

The authors recommend what ought to be done instead of the current practices. These recommendations include the focus on patients’ symptoms, what testing really needs to be done and which labs are the ones to see improvement in. This is what needs to happen and it is what my books and website have been saying for many years. Eventually, this will happen!

I highly recommend reading it. Many thanks to all three authors of the paper!

Here is the link to the new paper:

A PDF link to the paper can be read and downloaded via this link:

Best wishes,


Paul Robinson

Paul Robinson is a British author and thyroid patient advocate. The focus of his books and work is on helping patients recover from hypothyroidism. Paul has accumulated a wealth of knowledge on thyroid and adrenal dysfunction and their treatment. His three books cover all of this.

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  1. walt smith on 8th May 2023 at 3:11 am

    Good post, thank you.

    I do have a question : My understanding is that thyroid problems can result in Coronary Artery Disease. I do have that. Since I have few other symptoms (none serious except for CAD), am I correct in watching my CAD progress or regression as my only indicator of correct dosing? (heart scans for calcium scores have been my only indicators)

    Thank you.

    • Paul Robinson on 8th May 2023 at 10:50 am

      Good luck then Walt!

      Inadequate thyroid treatment (low FT3 and/or high rT3 and poor conversion) can cause heart issues yes.

      Take it easy and do track BP, heart rate, have regular EKGs etc.

      Best wishes, Paul

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