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Written by Dr. John C. Lowe as a response to Peter Warmingham, BSc (Hons), MIET and his paper on the topic with the same title (below).
Many examples in the history of science show that landmark advances in particular scientific fields often come from specialists in other fields. I firmly believe this is the case with Peter Warmingham and his hypothesis about the conventional error of using the TSH to adjust patients' dosages of thyroid hormone during their treatment for hypothyroidism.
As a way to introduce Peter Warmingham, I will briefly mention one of the many examples of landmark changes in scientific fields brought about by the thinking of specialists in other fields. Alfred Wegener is now recognized as the founding father of one of the major scientific revolutions of the 20th century, the concept of continental drift and plate tectonics. His hypothesis of continental drift came to him in 1912 and he announced the hypothesis in 1915. In the hypothesis, Wegener argued that all continents were once joined together in a single landmass and have drifted apart.
His book on the theory was published in the US in 1925. Its appearance set off vehement opposition by prominent geological scientists. Some of them disdainfully dismissed Wegener's hypothesis using the logical fallacy called ad hominem; that is, rather than debating the evidence he presented, they argued that he was wrong because he was not a geologist. This was true: Wegener was an astronomer who specialized in meteorology and climatology.
I mention Wegener and the logical fallacy used to denounce his hypothesis because I anticipate the same fate for Mr. Warmingham's hypothesis. The endocrinology specialty often uses the logical fallacy when researchers or clinicians not board certified in endocrinology present evidence that conventional beliefs of the endocrinology specialty are false. For example, when Dr. Steven Hotze challenged Dr. Bill Law (at the time President of the American Association of Clinical Endocrinologists) to debate on national television desiccated thyroid vs levothyroxine, Dr. Law declined. Among his reasons was that only board certified endocrinologists, which Dr. Hotze was not, are qualified to publicly comment on the treatment of hypothyroidism. If ad hominem is used to denounce the "Warmingham TSH Hypothesis," as I call it, I want our subscribers to recognize the fallacy and to appreciate its total irrelevance to whether or not the Warmingham hypothesis is right or wrong.
Intense opposition to Wegener's theory continued into the 1950s. But by the 1960s, accumulated scientific evidence showed that Wegener had been right. At the same time, it showed that prominent geological scientists who had scorned his theory were wrong. Modern plate tectonics is the direct descendent of Wegener's theory of continental drift. Today, plate tectonics is a thriving and productive scientific field. And humanity benefits from this field for a reason important to note: largely because Wegener's knowledge of scientific fields other than geology gave him a parallactic view of the origin of continents — a view that correctly meant that the contrary views of geologists had to be wrong. His parallatic view—rebuked by many because he was not a geologist—seeded the scientific soil for the fruitful growth of the science of geology from the 1960s on.
Examples such as Wegener's lead me to value proferted intellectual insights from those in fields other than thyroidology who nevertheless are knowledgeable in various aspects of thyroidology. Peter Warmingham is an exemplary example. He is an electrical and electronics engineer with special knowledge of control systems. The pituitary-thyroid axis is a biological control system, one which Mr. Warmingham clearly understands. His landmark hypothesis shows how a facility essential for successful performance in engineering—that is, exacting precision in analytical thought—has enabled him to see clearly what so many thyroidologists have long failed to see.
Mr. Warmingham's hypothesis is straightforward: When a hypothyroid patient (whose circulating pool of thyroid hormone is too low) begins taking exogenous thyroid hormone, a negative feedback system reduces the pituitary gland's output of TSH. This decreases the thyroid gland's output of endogenous thyroid hormone, and despite the patient's exogenous thyroid hormone's contribution to his or her total circulating thyroid pool, that pool does not increase—not until the TSH is suppressed and the thyroid gland is contributing no more thyroid hormone to the total circulating pool. At that point, adding more exogenous thyroid hormone will finally increase the circulating pool of thyroid hormone. The increase must occur for thyroid hormone therapy to be effective. The patient's suppressed TSH, then, does not indicate that the patient is over-treated with thyroid hormone; instead, it indicates that the patient's low total thyroid hormone pool will finally rise to potentially adequate levels.
The implication of the Warmingham TSH Hypothesis is clear: In general, if the clinician denies the patient more exogenous thyroid hormone because his or her TSH level is suppressed, the clinician will deny the patient enough thyroid hormone to increase the circulating pool of the hormone to a level adequate for maintaining normal thyroid hormone-driven cellular metabolic processes. But if the clinician continues to increase the patient's thyroid hormone dosage based on relevant measures of physiological function, such as the basal temperature, then the patient's health will be properly served despite his or her suppressed TSH level.
With this introduction, Thyroid Science presents to our subscribers what we believe to be a hypothesis of supreme importance to the proper treatment and health and well-being of hypothyroid patients.
The original paper:
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