Big toe jiont swollen , red and painful

[kimsmith1234]

Hi my husband has this week had his underactive thryiod blood done. 3.81. So thats ok. But he has a big toe, red swollen and painful. He was tested for gout about 5 years ago. Nothing. We have read things about this with thyriod , but he is very stressed at present , with his mum dying six weeks ago . His toot has been playing uo on and off for about 3 months. I think it gets worse when his more anxious. Any feed back will be helpful. Thsnks

[humanbean]

Just because he didn't have gout after a test 5 years ago, I can't see how it can have any bearing on whether or not he has gout now. He should ask his GP for a test.

[greygoose]

What was 3.81? His TSH? That's not alright at all. Much too high.

Does he have a diagnosis of hypo? Is he taking thyroid hormone replacement (levo, etc.) ?

[kimsmith1234 in reply to greygoose]

Thanks. I think he needs ti uo meds a little

[greygoose in reply to kimsmith1234]

He should increase by 25 mcg a day.

How much did the doctor increase his does by? Because it would have to be quite a bit to send him to A and E. Levo is pretty much just a storage hormone, and doesn't do much until it's converted into T3. And that doesn't happen instantly.

Does he ever have his FT4 and FT3 tested? TSH is not a good indicator of thyroid status because it can be affected by so many things.

[kimsmith1234 in reply to greygoose]

Yes on leveo. Takes 100. A dqy then also yalf a 12.5 twice a week. Doesnt trust docs, as twice suggested too much increase, and ended up at a n e

[jrbarnes]

I know my thyroid hormone is low when my toes, feet, fingers and wrists hurt. When it's extremely low my hands and wrists will swell like sausages, turn red, and become very painful to the touch. Once I was so alarmed by this that I went to the emergency and had x-rays. My thyroid hormone was increased and within two days the swelling and redness was gone. If 3.8 is his TSH then it's too high.

[kimsmith1234 in reply to jrbarnes]

Thankyou. I think he needs to up meds a little

[kimsmith1234 in reply to kimsmith1234]

He is on 100 then takes half a 12.5 twice a week. No trust in docs. As a coupllle of times up too high, gone to a n e, climbing the roof, now medicates himself , hes going to tske an extra quarter of 12.5. He is very sensative

[jrbarnes in reply to kimsmith1234]

goodness I'm a petite lady and take 100 mcg but that's a full replacement dose. Looks like your husband requires full replacement as well with a TSH over 3. My ex boyfriend was big and tall, had hypo but he only took 50 mcg, although he complained of being tired all the time, so I guess it's different for everyone. If you have the 25 mcg pills he could take an additional 25mcg with the 100mcg on MWF. That would increase the weekly amount by 75 mcg. I don't like splitting pills if it's not necessary and by skipping a day in between he should be able to take 125 mcg on MWF or he could still split and do 112 per day.

[arTistapple in reply to jrbarnes]

Thank you for raising this. I have not seen this (yet another to add to our mixed bag of symptoms) mentioned anywhere else. Presently suffering and thinking gout but know that I am extremely likely to be under medicated and I am in the process of organising private testing this week. The range of symptoms is mind boggling. If we did not have this exchange of information on this forum …….. ?

[jrbarnes in reply to arTistapple]

I know now after years of suffering mysterious symptoms that 99.9 % are thyroid related! They will try to diagnose you with other autoimmune diseases rather than agree that you're under treated on thyroid hormone or that there could be an issue with thyroid conversion.

[arTistapple in reply to jrbarnes]

I love your use of the word mysterious. It’s absolutely on the button. 25 years of this ‘mysterious’ coronary spasm plus heart attack, which I finally gave up on the medics and self managed and I see others on the BHF page suffering same. The researchers are covering the same old ground they were 20 years ago. I am not suggesting that everyone with coronary spasm has thyroid problems but …… it should be checked carefully. That is if the medics understand anything much about thyroid stuff AND can read the test results!

[jrbarnes in reply to arTistapple]

Sounds logical for a medical professional to investigate thyroid as a cause when you're already diagnosed with thyroid problems! We need special institutions that are dedicated solely to the diagnosis and treatment of thyroid disease.

[humanbean in reply to arTistapple]

25 years of this ‘mysterious’ coronary spasm plus heart attack, which I finally gave up on the medics and self managed and I see others on the BHF page suffering same.

Can I ask... How do you self-manage coronary spasm?

I've been diagnosed with angina after I went to hospital several times with severe chest pain, several years ago. I've never had a heart attack or a stroke. I take Bisoprolol for tachycardia but only when my heart goes too fast. My blood pressure is quite variable but is usually "normal". I refused statins.

The thing is I no longer get chest pain, and haven't had it for about 6 or 7 years. It went away once I raised my iron and ferritin as close to optimal as I could get them. Chest pain is a known symptom of very low iron/ferritin but it very rarely gets mentioned anywhere. I monitor my own iron and ferritin, and also my own thyroid treatment.

[arTistapple in reply to humanbean]

Humanbean, I realised when you asked the question ‘self managed’ that that, may not be entirely accurate. More a withdrawal from heavy medication which provided no relief whatsoever and I am of the opinion was further damaging my health. I learned to watch very closely the factors which brought it on and did what I could to AVOID them, which really was far from successful. Worst of all, my condition was/is not at all compatible with what might be called a fulfilling life. Different sufferers have different patterns of pain. There are a few people on the BHF forum of HealthUnlocked who are talking about their vasospastic or microvascular symptoms. For me it was pure survival instinct giving up the useless medications. What can you do when you give doctors every chance to help you and they can’t/won’t? Isn’t this just the story of every thyroid patient on this forum? It may be a slightly different path but the end result looks remarkably similar. I know my ferritin is high and I agree wholeheartedly with my doctor on this occasion, that this is an inflammation marker - hardly surprising with what he is calling ‘acquired’ thyroiditis. I have no doubt there is inflammation around my heart too. Not so big a surprise really. I did take statins for a while. Again side effects were unwelcome. I read enough research that led me to understand that the whole cholesterol charade was not for me. However there are many people who think it is very important so I don’t want to appear disrespectful or nutty. I don’t have the time to make the arguments for or against any of that stuff at the moment. My focus is on getting effective treatment for my thyroid condition, learning how to read my tests with the help of the excellent people on this forum and wasting as little time as possible. P.S. I have mentioned elsewhere that levothyroxine has given me a pain free heart for a year. The first for at least 25 years. Thanks again for your interest Humanbean. Love your contributions.

[mstp]

What does MWF sta d for?

[grauntieannie in reply to mstp]

Monday, Wednesday, Friday!

[SueHG]

I was hypo and before I was started on t3 by Dr P my heart rate was very low and I had to have a pacemaker fitted. The heart consultant said that the damage to the heart valve was caused by low t3. All the occupants of the heart ward had thyroid problems.

[Miffie]

I think he should visit the GP it sounds like gout to me. I have had it in my toe and it’s very debilitating but can be sorted usually naproxen given. It may be thyroid related but if it’s gout it can be fixed quickly while thyroid takes longer.

[Heloise]

It does sound like gout and sometimes it is caused by other medications. If he takes something other than thyroid hormone, look at the side effects of all his meds. There are certain foods and alcohol which also contribute to gout.

[HMBradley53]

It sounds like gout he needs to get his zuric Acid tested my husband got it all of the time. It comes and goes depending on the fod he eats or if he drinks beer. High Uric acid comes and goes only when your in a flair he needs meds to stop it and check the food list.

[Teuchter]

Hi. I suffer from gout from time to time. AFAIK, gout (caused by high levels of uric acid) is more common in people with underactive thyroids, as is high cholesterol. When I have a flare-up, I've found that what works for me is:

1: Black cherry juice: it used to be available in concentrate from Holland&Barrett, but the last time I went to buy some, they said it has been discontinued, the closest substitute being capsules, which didn't work as well for me on that occasion. I drank as much of it as I could stomach until the gout subsided.

2: Water: uric acid is broken down by the kidneys AFAIK, so drinking plenty of water is important.

3: I take an extra 100mcg levothyroxine tablet each day, until the gout subsides: BUT I'M NOT RECOMMENDING THIS TO YOUR HUSBAND, LEST HE ENDS UP IN A&E AGAIN; i'm just saying that I think it hastens the end of the flare-up, for me personally.

4: I stay off the booze for a week or so.

I have heard that GPs treat a flare-up by prescribing Colchicine; for repeated flare-ups caused by chronically high levels of uric acid, they prescribe Allopurinol. Despite being a layman with no medical training, my hunch would be that high uric acid levels, as well as high cholesterol, would be less likely to occur if patients had their thyroid problems properly treated.

Good luck

Geoff.

[kimsmith1234]

Thanks for alo yourcomments. How much would anyone suggest he takes extra to get 3

[smwdorset]

Sorry but sounds like gout to me and my daughter who has kidney problems always gets a flare up when she is under stressThis is treatable

The pain is intense without treatment

Go back to your GP and demand a blood test or in extremis

And I

Mean if all this fails go to your local A and E and tell them your GP Has refused a blood test despite the symptoms and the context of stress

Good

Luck

[humanbean]

I came across this description of how treatment for gout works using Allopurinol which I gather is one of the most common treatments.

Allopurinol lowers plasma rate levels. That in itself does not stop gout because gout is due to shifting around of crystal deposits that have taken months or years to build up in joints and take about three months to dissolve once irate levels are low enough for that to happen. Moreover, while the crystals are dissolving gout tends to be more likely to occur perhaps because the deposits become unstable.

So you need to explain to the patient that the first objective is to go on taking allopurinol for at least three months, whether or not they have any attacks, which they may well do, to get rid of deposits.

Once the deposits have gone the situation is different. Continuing with allopurinol is designed to prevent new deposits forming over a long period. If the rate has come down with weight loss in the interim there may be no need. If no attacks of gout occur it is not unreasonable to stop allopurinol for a while if it is inconvenient to take - perhaps on holiday. The decision to continue long term in the face of no deposits and no attacks is a matter of weighing up pros and cons. Most intelligent people would probably agree that it is worth taking the drug to prevent another attack maybe in a year or so's time, but if the rate level is not very high they might get away without it.

[humanbean in reply to humanbean]

Where this guy (a retired rheumatologist) talks about rate levels and irate levels I think he must be talking about urate.

en.wikipedia.org/wiki/Uric_...

[tattybogle in reply to humanbean]

Re. allopurinol... just found this ......seems it has some potential issues in patients with thyroid problems .. ? affects fT4, fT3 ,levels but not TT4/TT3 ... ? binding / transportation.

Related post with links to some studies:

healthunlocked.com/thyroidu....

NHS medicines document for allopurinol:

nhs.uk/medicines/allopurinol/

" 3. Who can and cannot take allopurinol

Allopurinol can be taken by adults and sometimes children.

Allopurinol is not suitable for certain people.

Talk to a doctor or pharmacist if you:

have ever had an allergic reaction to allopurinol or any other medicine

are of Han Chinese, Thai or Korean origin

have problems with your liver or kidneys

currently have an attack of gout

have thyroid problems "

[humanbean in reply to tattybogle]

I never thought to look for interactions with anything. Thanks.

[Miffie in reply to tattybogle]

Blimey, I take Allopurinol every day . The rheumatologist prescribed it for life due to gout in my ankle. Weird I know because it wasn’t as painful as periodic bouts I have had in my big toe which required both Allopurinol and Naproxen. Think I may need to check out the Allopurinol contra indications as I had ckd diagnosed after Allopurinol was prescribed some 10 years ago.