Endocrine Abstracts

Introduction: Thyroid hormones in fluence kidney function and thereby might alter serum urate levels, a major risk factor for gouty arthritis. Previous research documented a high prevalence of elevated levels of Uric acid in primary hypothyroid patients. We present the case of an incident gout attack in a patient with primary hypothyroidism.

Case report: A 72-year-old male was hospitalized for a primary hypothyroidism complicated by a rhabdomyolysis. Laboratory examinations reveled a low serum FT4 = 3.67 pg/ml (NR 7–18) and an elevated serum TSH = 46.6 IU/l, eGFR =42. The patient was treated initially with levothyroxine 12,5 µg/day . During his hospitalization, he complained of sudden onset of throbbing pain in the right wrist, rankles and metacarpophalangeal joints in a context of apyrexia. Physical examination disclosed marked deformities of his hands, feet, and synovitis localized to his wrist and ankle on the right side. The squeeze test was positive. There was no Tophi. Serum uric acid was severely elevated 731 umol/l (180-420). Sedimentation rate was normal. Joint X-rays rule out other causes of joint inflammation. Immunological investigation was negative. The diagnosis of a gout attack was finally retained. The patient was therefore referred to rheumatology department.

Conclusion: This case illustrates an incidental gout attack that was precipitated by primary hypothyroidism in a patient who had no history of gout disease. This leads us to check regularly uric acid in patients with hypothyroidism and to check the thyroid status in patients who presents for gout attack.