The association between thyroid disorders and incident gout: population-based case-control study

Regularly monitoring thyroid hormone levels and adjusting medication dosage are essential to manage hypothyroidism effectively. While treating hypothyroidism does not directly resolve gout, optimal thyroid treatment may help improve the response to gout treatment. Plots of MR estimates of the causal relationship between thyroid disease and gout with 4 methods (IVW approach, MR-Egger, weighted median, weighted mode). (b) Forest plot of the comparison of subclinical hypothyroidism and subclinical hyperthyroidism. (d) Funnel plot of the comparison of subclinical hypothyroidism and subclinical hyperthyroidism. We additionally adjusted the analyses for lifestyle factors (alcohol consumption and smoking status) and concomitant diseases such as hypertension, congestive heart failure, ischemic heart disease, and renal impairment.

Although the diagnosis of gout has been validated and found to be well documented in the CPRD,27 there may still be some outcome misclassification. Gout diagnoses are often made based on clinical presentation and are rarely confirmed in routine clinical practice by analysis of aspirated joint fluid for evidence of urate crystals. To minimize misclassification, we only included gout patients who had no differential diagnoses of gout such as osteoarthritis, septic arthritis, hemochromatosis, and rheumatoid arthritis recorded at any time within their patient record.

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• The correlation between TSH and serum uric acid levels was weak 16, 17.
• During a physical examination, the doctor should assess the affected joint for tenderness, inflammation, and tophi (deposits of uric acid crystals).
• This is a common problem when dealing with laboratory values or biomarkers that are an important part of diagnostic assessments.
• Gout is typically diagnosed using a combination of medical history, physical examination, and laboratory tests.
• We therefore assessed the risk of developing incident gout in association with hypo- or hyperthyroidism and thyroid hormone replacement or suppression therapy, respectively.
• Patients to be started on allopurinol who had a measurement of TSH in the 6-month period prior to baseline evaluation were used for comparison.

One reason for this is the consideration of renal function as a covariate in our study. Reduced renal function is a major risk factor for hyperuricemia 31, 32 since kidney is the major organ handling urate metabolism. It is interesting to observe hyperuricaemia in patients with hyperthyroid status, who are expected to have ahigher renal clearance of uric acid. On reason may be the increased uric acid production secondary to increased overall metabolism in hyperthyroid patients surpassing uric acid diuresis caused by hyperthyroidism 19. We found an association between allopurinol use and an increased TSH level using a CDM based on the synthroid ranges EMRs of 19,200,973 patients in the distributed databases of seven hospitals. All medications and diseases considered confounding variables showed significant differences between the case and control groups.

Sensitivity analyses

Gout most commonly affects the joints in the big toe but can also occur in other joints, such as the ankles, knees, elbows, wrists, and fingers. To assess the risk of developing incident gout in association with hypothyroidism or hyperthyroidism. Due to the heterogeneity of the studies included, in order to further increase the reliability of the study, a subgroup analysis of age, area, and comorbidities in patients was performed. To reduce bias, we collected and reviewed the source values and standard codes of each hospital in advance and selected 5 out of 108 items for TSH. We confirmed that all seven hospitals participating in the study received laboratory accreditation from the Laboratory Medicine Foundation ensure the reliability of test result. Besides, we collected the normal range for TSH from the seven hospitals participating in the study.

Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences. This CDM allows for a range of standard queries and analytic methods developed centrally to be run seamlessly in both the distributed and centralised environments, potentially leading to rapid quality-assured results18. The MOA CDM from the Korea Institute of Drug Safety and Risk Management includes the Sentinel CDM from the US Food and Drug Administration and the Observational Medical Outcomes Partnership (OMOP) CDM from Observational Health Data Sciences and Informatics (OHDSI)19.

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Inclusion and exclusion criteria and TSH level in patients with SCH/SCHyper of included studies. Nevertheless, we provided evidence for the safety of the medication using multicentre CDM data. Though allopurinol labels have recently changed in Korea based on previous research and approval from other countries, there has been a lack of relevant large-scale analysis to date. We analysed the FT4 and T4 values before and after the index date of the case group.

• For diagnosis, management, and optimized treatment of their hypothyroidism, more thyroid patients are choosing to work with Paloma’s top thyroid doctors.
• On reason may be the increased uric acid production secondary to increased overall metabolism in hyperthyroid patients surpassing uric acid diuresis caused by hyperthyroidism 19.
• The adjusted OR for the risk between increased TSH and allopurinol use in each hospital, after an aggregated meta-analysis, was 1.51 (95% CI; 1.32–1.72).
• The committee did not require written informed consent be obtained from the participants, as this was a retrospective study, and all data was anonymized.
• The OMOP CDM is the most widely used model, developed and managed by the OHDSI in Korea.
• Additional analysis confirmed the potential for the development of SCH.

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When levels of these hormones are low, it can slow down the body’s processes, leading to fatigue, weight gain, and muscle and joint pain, including gout. Thyroid hormones influence kidney function and thereby might alter serum urate levels, a major risk factor for gouty arthritis. Medications included those that could affect TSH levels26,27,28,29,30,31,32,33,34 and medication used by gout patients, such as non-steroidal anti-inflammatories, acetaminophen, oxycodone, colchicine, and corticosteroids35,36 (Supplementary Table S3).

• On the other hand, hypothyroidism is a condition characterized by an underactive thyroid gland.
• Uric acid is usually filtered out by the kidneys and excreted by the kidneys in urine.
• Participants were categorized as having euthyroid, hypothyroid, or hyperthyroid status according to their thyroid-stimulating hormone (TSH) levels.
• Thyroid hormones play a role in regulating enzymes involved in the breakdown and elimination of uric acid.

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Ford HC et al. also indicated that hyperthyroidism can cause hyperuricemia by increasing UA production or decreasing renal excretion 32. The association between hypothyroidism and hyperuricemia was first proposed by Kuzell et al. in 1955 33; subsequent studies confirmed this association. A previous study showed that hyperthyroidism resulted in elevated levels of UA, but the increase was less than in hypothyroidism 31, which were similar to our results. Past studies have reported an association between hyperuricaemia and thyroid disorders with conflicting results. The correlation between TSH and serum uric acid levels was weak 16, 17, which is consistent with our findings. However, the previous study has reported significantly higher prevalence of hyperuricaemia in patients with hypothyroidism 18.

Finally, a total of 73 articles were included in the meta-analysis (Figure 1). We did not exclude any studies in the review based on the comorbidities of the study participants, but we kept into account this aspect when summarizing the results. Supplementary Materials (Table S1) provide the basic characteristics of included studies. Purines are also found in certain foods, including red meat and organ meats, such as liver.

1 shows the sex-specific prevalence of hyperuricaemia and gout in euthyroid, hypothyroid, and hyperthyroid individuals. In women, the prevalence of gout and hyperuricaemia were significantly higher in both hypothyroid and hyperthyroid individuals than in euthyroid individuals. The aim of this study was to estimate the risk of hyperuricaemia and gout in people with hypothyroid or hyperthyroid status. Second, increasing the consumption of low-fat dairy products such as milk, yogurt, and cheese can help lower the risk of gout attacks. These products contain compounds that are believed to reduce uric acid levels. Gout is a form of inflammatory arthritis typically caused by the overproduction or underexcretion of uric acid in the body, a condition known as hyperuricemia.