My sister, 56 years of age, has just developed gout. She has Hashimotos's and since this summer increased her dose of T4 to 200mcg and introduced 20mcg of T3 ( on advice of a functional medicine endocrinologist). She is heterozygous for the D102 mutation which runs in the family, has a fatty liver and gallstones. But even with these issues for many years has never had gout.
Since the increased dose ( from 100mcg to 200mcg of T4) she has gained a ton of weight ( she has had weight issues since her teens) and is now her heaviest since the dose increase. Does T4 make you gain weight ? why ?
When she tried to reduce her dose to 150mcg of T4 and 10mcg of T3 (on the advice of an endocrinologist) she fainted, had balance problems, was ill with other symptoms and was taken to the ER. A CT scan showed all was ok.
Her labs, ie Thyroid profile/ liver function are out of the reference ranges. But the gout in her knee is a new development. It is painful and debilitating and along with the out of range labs has scared and depressed her.
Is there a connection between the increase dose of T4, the introduction of the T3 and the onset of the gout?
Or is it indirect ie due to the weight gain ? my understanding was the T3 helped increase metabolism? The introduction of the T3 has certainly helped her mentally cope with life stresses and significantly reduced water retention but she feels this has caused her additional physical problems like the gout.
Her cortisol levels have yet to be checked.
I would be grateful for any input and thanks for taking the time to read this.
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Sheba678
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I'm fairly sure that in the past there was thought to be an association between gout and hypothyroidism. However, this study, published in 2017 seems to suggest otherwise. ncbi.nlm.nih.gov/pmc/articl...
Conclusion
This large observational study does not provide evidence that hypothyroidism or hyperthyroidism, irrespective of treatment, is associated with a clinically relevant increased risk of developing incident gout. There may be an exception among patients with newly diagnosed and treated hypothyroidism.
Your sister has had huge increase in Levothyroxine
Usually dose is only increased very slowly in 25mcg steps
She needs FULL Thyroid and vitamin testing
For full Thyroid evaluation she needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
Is this how you do your tests?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.
So it's important to get TPO and TG thyroid antibodies tested at least once .
if she needs to reduce dose of Levothyroxine then it needs to be done extremely slowly and carefully. Many people struggle to even reduce by 12.5mcg at a time, certainly cutting Levothyroxine by 50mcg would likely cause terrible symptoms
Suggest she gets full testing and comes back with new post once she has results
I will pass this on to her, thanks for the advice.
I don't care what any medical "experts" may say, there does seem to be such an association. In my case, without a thyroid gland and on levo monotherapy, this developed after several years. I could not say whether this resulted from the inappropriate medication or from the resulting weight problem but happen it did!
Now on NDT but the problem still exists but in a different form. I have very infrequent pain in both big toes but this pain then gradually moves to the heel and then disappears over a few weeks. I remain with a permanent numbness in both big toes which refuses to go away.
Have visited podiatrist but I don't think she had a clue as all she did was tickle my toes and recommend I get wider shoes. But I had already taken that route with width 6E from Wider Fit Shoes for my size 12's.
Hope this account of a real world experience helps you.
Thanks very much, I will pass this on to her, I hope your numbness will resolve in time. Have you tried a B complex ? ( liquid drops for easier absorption) this may help with numbness.
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