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A persistently elevated thyroid stimulating hormone (TSH) level is a common clinical problem in primary hypothyroidism patients treated with levothyroxine (LT4). "Pseudomalabsorption", which is characterized by poor adherence,should be considered in cases of refractory hypothyroidism after excluding other causes, such as malabsorption.

Refractory Hypothyroidism to Levothyroxine Treatment: Five Cases of Pseudomalabsorption