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
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
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
Effect of exogenous thyroid hormone
intake on the
interpretation of serum TSH test results. Thyroid
Science, 5(7)1-6, 2010.
in pdf format)
© 2010 Thyroid Science