Purpose: To examine the potential relationship between gout and hypothyroidism.
Patients and methods: Fifty-four consecutive patients with a diagnosis of monosodium urate crystal-proven gouty arthritis on joint aspiration were prospectively evaluated for hypothyroidism with an ultrasensitive thyroid-stimulating hormone (TSH) assay. Twenty-five patients with a diagnosis of monosodium urate crystal-proven gout were retrospectively identified from a population of 137 patients receiving uric acid-lowering medications. These patients were also screened for hypothyroidism. Age, race, sex, and weight matched patients with noninflammatory rheumatic diseases and no history of gout served as controls. Hypothyroidism was diagnosed when a TSH was greater than 6.0 microU/mL or if a history of hypothyroidism requiring replacement therapy was documented.
Results: The prevalence of hypothyroidism in the prospective group was significantly increased compared to controls (P < 0.05). Overall 15% of these patients, 25% of women and 12% of the men, had hypothyroidism. These rates were 2.5 times greater in women and 6 times greater in men than found in the controls. The mean TSH of the prospective gouty patients was also significantly greater than those levels found in control patients (5.2 +/- 12 versus 1.8 +/- 1.1 microU/mL, P < 0.05, chi-square), even when all abnormally elevated TSH values were excluded from analysis. The prevalence of hypothyroidism in the retrospective group was even higher: 20% overall, 40% in women and 15% in men.
Conclusions: The prevalence of hypothyroidism is significantly increased in patients with aspirate-proven gouty arthritis. Screening for hypothyroidism with an ultrasensitive thyroid-stimulating hormone assay should be considered in all patients presenting with gouty arthritis and those with a history of recurrent gouty flares.