Association between the use of allopurinol and risk of increased thyroid-stimulating hormone level

We adjusted analyses for comedication use of diuretics, all other antihypertensive drugs assessed (including nitrates), and statins, recorded at any time prior to the index date. Serum TSH measurement is the single most reliable test to diagnose all common forms of hypothyroidism and hyperthyroidism40. The best way to initially test thyroid function is to measure TSH levels in a blood sample41.

• We analysed the FT4 and T4 values before and after the index date of the case group.
• Patients with abnormal TSH levels or previous thyroid disease or on amiodarone were not included for analysis.
• It may be possible that patients who just started their treatment of hypothyroidism may be at greater risk of gout because a potential protective effect of thyroid hormone replacement therapy did not yet become active.

Association between the use of allopurinol and risk of increased thyroid-stimulating hormone level

The prevalence synthroid emotions of hypothyroid and hyperthyroid status were 1.7% (men, 1.1%; women, 2.3%) and 3.2% (men, 2.4%; women, 4.2%), respectively. Baseline characteristics stratified by thyroid status are shown in Table 1. Mean serum levels of uric acid did not differ among euthyroid, hypothyroid, and hyperthyroid subjects.

Hyperuricemia and gout in thyroid endocrine disorders

Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body. Observational databases have different logical organisations and physical formats, and terminologies used to describe medicinal products and clinical conditions vary across sources17. A common data model (CDM) could be used to create a standardised data structure to utilise hospital data efficiently to overcome these difficulties. The CDM is a distributed database system of encrypted and de-identified information that identifies patients and converts their information to secondary data sources in a common format.

Patients with gout should get regular thyroid screening to monitor any changes in thyroid function. The Paloma Home Thyroid Test kit can make it easy and affordable to get a complete thyroid panel from the comfort of your home. Relationship between SCH and serum UA levels before and after treatment. External quality control for laboratory data was provided through participation in an international program implemented by the College of American Pathologists, as well as the National Quality-Control Program in Taiwan.

(d) Subgroup analysis of subclinical hyperthyroidism, grouped by basic diseases. (d) Subgroup analysis of subclinical hypothyroidism, grouped by basic diseases. Medications included those that could affect TSH levels26–34 and medication used by gout patients, such as non-steroidal anti-inflammatories, acetaminophen, oxycodone, colchicine, and corticosteroids35,36 (Supplementary Table S3). We did not adjust for all potential risk factors for gout, since, for example, dietary habits or physical activities2,31 are not routinely recorded in the CPRD. However, we adjusted for BMI, a factor that is related to physical activity and dietary habits. Furthermore, we were not able to take race/ethnicity into account when calculating eGFR with the CKD-EPI formula because ethnicity information is not consistently available in the CPRD.

Table 1.

The results of this MR Showed that gout had no causal relationship with autoimmune hypothyroidism, autoimmune hyperthyroidism, thyroid cancer and thyroid nodule. For diagnosis, management, and optimized treatment of their hypothyroidism, more thyroid patients are choosing to work with Paloma’s top thyroid doctors. Paloma’s thyroid-savvy team of practitioners work with you to develop an effective treatment plan, including thyroid medications and lifestyle changes that can safely normalize your thyroid function for optimal health. To confirm the diagnosis and rule out other possible causes of joint pain, laboratory tests such as blood tests to measure serum uric acid levels, joint fluid analysis to check for uric acid crystals or imaging tests like X-rays or ultrasound may be conducted. Combining these approaches helps diagnose gout accurately and determine the most appropriate treatment plan.

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). Regarding the additional analysis of patients who used allopurinol, the mean maximum TSH level was 12.52 mIU/L and the highest level was 16.92 mIU/L at hospital G. Since free T4 levels were all within the normal reference range even after the case group index date (that is, when the TSH level increased), the possibility of subclinical hypothyroidism (SCH) could be suspected38,39. Increase in thyroid stimulating hormone (TSH) levels over the upper normal limit has been reported in a small percentage of patients treated with febuxostat in clinical trials, but a mechanistic explanation is not yet available. In an observational parallel longitudinal cohort study, we evaluated changes in TSH levels in patients with gout at baseline and during urate-lowering treatment with febuxostat.

Data source and study design

In addition, thyroxin replacement in patients with hyperthyroidism was reported to reverse hyperuricaemia 18, 30. Evidence regarding the relationship between hyperuricaemia and hyperthyroidism is even more limited. In one study, hyperuricaemia was found in 5 out of 18 hyperthyroid patients (27.7%) 18. Another study found that patients with hyperthyroidism due to Graves’ disease had significantly higher serum uric acid levels than age- and sex-matched controls 19. To our knowledge, this is the first study to investigate the causal relationship between thyroid diseases (autoimmune hypothyroidism, autoimmune hyperthyroidism, thyroid nodules, and thyroid cancer) and gout. In this MR Study, we found that autoimmune hypothyroidism and autoimmune hyperthyroidism have positive causal effects on the risk of gout.

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SCH implies an absence of symptoms; however, it is perhaps better thought of as mild hypothyroidism62. Moreover, even mild hypothyroidism can progress to overt hypothyroidism63,64. Hypothyroidism is permanent in most patients and therefore requires hormone replacement over a lifetime65. Therefore, it is essential to provide evidence for the safety of the medication.

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The total population of all CDM databases was 19,200,973 patients from seven hospitals. A total of 2,298,492 patients were registered in the cohort according to the inclusion criteria, and 605,420 patients were excluded. Additionally, gout increases the risk of developing other health conditions such as hypertension, heart disease, and diabetes. These complications can profoundly impact the overall quality of life and require ongoing management and treatment to prevent further damage and reduce the risk of future gout attacks. The systematic literature search retrieved 1983 publications; after exclusion of duplicates and screening for relevance in title and abstract, 1429 publications were further appraised in full text. In the second step, full texts were reviewed for eligibility and relevance of their findings, and 1094 articles were excluded due to duplicate data, review articles, and insufficient relevance.