Hyperthyroid and Hypothyroid Status Was Strongly Associated with Gout and Weakly Associated with Hyperuricaemia

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Abstract

Objectives

The aim of this study was to estimate the risk of hyperuricaemia and gout in people with hypothyroid or hyperthyroid status.

Methods

This study analyzed data from individuals who participated in health screening programs at Chang Gung Memorial Hospital in northern Taiwan (2000–2010). Participants were categorized as having euthyroid, hypothyroid, or hyperthyroid status according to their thyroid-stimulating hormone (TSH) levels. Multinomial logistic regression models were used to calculate the odds ratios (95% CI) for hyperuricaemia and gout in participants with thyroid dysfunction compared to euthyroid participants.

Results

A total of 87,813 (euthyroid, 83,502; hypothyroid, 1,460; hyperthyroid, 2,851) participants were included. The prevalence of hyperuricaemia was higher in hyperthyroid subjects (19.4%) than in euthyroid subjects (17.8%) but not in hypothyroid subjects (19.3%). The prevalence of gout was significantly higher in both hypothyroid (6.0%) and hyperthyroid (5.3%) subjects than in euthyroid subjects (4.3%). In men, hypothyroid or hyperthyroid status was not associated with hyperuricaemia. However, hypothyroid or hyperthyroid status was associated with ORs (95% CI) of 1.47 (1.10–1.97) and 1.37 (1.10–1.69), respectively, for gout. In women, hypothyroid status was not associated with hyperuricaemia or gout. However, hyperthyroid status was associated with ORs (95% CI) of 1.42 (1.24–1.62) for hyperuricaemia and 2.13 (1.58–2.87) for gout.

Conclusions

Both hyperthyroid and hypothyroid status were significantly associated with gout and weakly associated with hyperuricaemia. A thyroid function test for gout patients may by warranted.

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Most cited references 28

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Preliminary criteria for the classification of the acute arthritis of primary gout.

S L Wallace, H. Robinson, A T Masi … (1977)

The American Rheumatism Association sub-committe on classification criteria for gout analyzed data from more than 700 patients with gout, pseudogout, rheumatoid arthritis, or septic arthritis. Criteria for classifying a patient as having gout were a) the presence of characteristic urate crystals in the joint fluid, and/or b) a topus proved to contain urate crystals by chemical or polarized light microscopic means, and/or c) the presence of six of the twelve clinical, laboratory, and X-ray phenomena listed in Table 5.

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Independent impact of gout on mortality and risk for coronary heart disease.

Hyon K Choi, Gary Curhan (2007)

Although gout and hyperuricemia are related to several conditions that are associated with reduced survival, no prospective data are available on the independent impact of gout on mortality. Furthermore, although many studies have suggested that hyperuricemia is associated with cardiovascular disease (CVD), limited data are available on the impact of gout on CVD. Over a 12-year period, we prospectively examined the relation between a history of gout and the risk of death and myocardial infarction in 51,297 male participants of the Health Professionals Follow-Up Study. During the 12 years of follow-up, we documented 5825 deaths from all causes, which included 2132 deaths from CVD and 1576 deaths from coronary heart disease (CHD). Compared with men without history of gout and CHD at baseline, the multivariate relative risks among men with history of gout were 1.28 (95% confidence interval [CI], 1.15 to 1.41) for total mortality, 1.38 (95% CI, 1.15 to 1.66) for CVD deaths, and 1.55 (95% CI, 1.24 to 1.93) for fatal CHD. The corresponding relative risks among men with preexisting CHD were 1.25 (95% CI, 1.09 to 1.45), 1.26 (95% CI, 1.07 to 1.50), and 1.24 (95% CI, 1.04 to 1.49), respectively. In addition, men with gout had a higher risk of nonfatal myocardial infarction than men without gout (multivariate relative risk, 1.59; 95% CI, 1.04 to 2.41). These prospective data indicate that men with gout have a higher risk of death from all causes. Among men without preexisting CHD, the increased mortality risk is primarily a result of an elevated risk of CVD death, particularly from CHD.

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Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study.

Kwang-Seok Choi, Susanna Atkinson, Gary Curhan … (2005)

Limited prospective information exists on the relation between obesity and weight change and the risk of gout. Similarly, both hypertension and diuretic use have been considered risk factors for gout; however, their independent contributions have not been established prospectively. We prospectively examined over a 12-year period (1986-1998) the relation between adiposity, weight change, hypertension, and diuretic use and incident gout in 47,150 male participants with no history of gout at baseline. We used a supplementary questionnaire to ascertain the American College of Rheumatology criteria for gout. During 12 years we documented 730 confirmed incident cases of gout. Compared with men with a body mass index (BMI) of 21 to 22.9, the multivariate relative risks (RRs) of gout were 1.95 (95% confidence interval [CI], 1.44-2.65) for men with a BMI of 25 to 29.9, 2.33 (95% CI, 1.62-3.36) for men with a BMI of 30 to 34.9, and 2.97 (95% CI, 1.73-5.10) for men with a BMI of 35 or greater (P for trend <.001). Compared with men who had maintained their weight (+/-4 lb) since age 21 years, the multivariate RR of gout for men who had gained 30 lb or more since age 21 years was 1.99 (95% CI, 1.49-2.66). In contrast, the multivariate RR for men who had lost 10 lb or more since the study baseline was 0.61 (95% CI, 0.40-0.92). The multivariate RRs of gout were 2.31 (95% CI, 1.96-2.72) for the presence of hypertension and 1.77 (95% CI, 1.42-2.20) for diuretic use. Higher adiposity and weight gain are strong risk factors for gout in men, while weight loss is protective. Hypertension and diuretic use are also important independent risk factors for gout.

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Author and article information

Contributors

Guoying Wang: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2014

Publication date (Electronic): 8 December 2014

Volume: 9

Issue: 12

Electronic Location Identifier: e114579

Affiliations

[1 ]Department of Public Health, & Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan

[2 ]Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

[3 ]Division of Academic Rheumatology, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom

[4 ]Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan

[5 ]Health Evaluation Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

[6 ]First Division of Cardiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Johns Hopkins Bloomberg School of Public Health, United States of America

Author notes

* E-mail: gout@ 123456cgmh.org.tw

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: LCS CFK KHY. Performed the experiments: CFK. Analyzed the data: CFK MJC JRL. Contributed reagents/materials/analysis tools: SFL IJC YSK. Wrote the paper: LCS CFK KHY SFL IJC YSK MJC JRL.

Article

Publisher ID: PONE-D-14-31769

DOI: 10.1371/journal.pone.0114579

PMC ID: 4259336

PubMed ID: 25486420

SO-VID: a89b19ed-f6af-46b7-b779-6e35b8c92e3c

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 17 July 2014

Date accepted : 11 November 2014

Page count

Pages: 10

Funding

The authors would like to thank the Ministry of Education, Taiwan (EMRPD1D0101) and Chang Gung Memorial Hospital (CMRPG390211) for financially supporting this research in data collection and analysis, and preparation of the manuscript.

Custom metadata

Data Availability The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. Data are from the Chang Gung Memorial Hospital, Taiwan. The data are available to interested researchers but cannot be made publicly available due to ethical concerns raised by the hospital's ethical committee. Readers can contact the corresponding author to obtain raw data.

Hyperthyroid and Hypothyroid Status Was Strongly Associated with Gout and Weakly Associated with Hyperuricaemia

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Abstract

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Conclusions

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PLOS Climate

Most cited references 28

Preliminary criteria for the classification of the acute arthritis of primary gout.

Independent impact of gout on mortality and risk for coronary heart disease.

Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study.

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