This paper might well stretch your digestive system.
This paper by Leese encapsulates what is wrong with British thyroidology. First it commits the sin of partiality - no mention of our paper on exactly the same topic published years ago. Second, it persists with faulty ideas - Weetman - a fan of alleging somatic disorder in patients that don't do well on T4 only. The group is now in this paper scratching its collective head about something being rotten in the state of Denamrk (to quote Shakespeare) but not having a clue about why and what to do about except fluttering its impotent wings. Thirdly it can't let go entirely of its old beliefs - they have to somehow be rationalised but have no idea how. Just rehash the old somatic argument -eg you are depressed so it can't be thyroid disease. Fourthly it still parrots the notion of normalisng TSH, when studies it apparently shrugs off that cold fact that healthy TSH range cannot be used in this way. Talk about Dick's days. Their idea are pre-Dick.
My Colleague Rudolf Hoermann expressed his surprise about Leese's position in view of his other paper on stable T3 therapy.
He did a good long-term study on LT3, so his comments really surprised me. If it does not fit, look for co-morbidities or something else to blame, rather than questioning whether something might be wrong with the approach.
Time to Refresh thinking on the terminology and management of hypothyroidism
G Leese & E Soto-Pedre