Many causes of malabsorption of levothyroxine in patients with hypothyroidism have been thoroughly described in literature. Pseudomalabsorption, poor compliance of the patient with the therapy regime, is the most common cause of failure of levothyroxine therapy. Pseudomalabsorption is characterised by a deficient diagnostic process, patient denial and difficulties in treatment. The present article provides guidelines in diagnosing and treating pseudomalabsorption in hypothyroidism.