MR Spectroscopy in the management of tophaceous gout

Development of chronic tophaceous arthritis with marked joint impairment may follow repeated acute attacks. We present a 60 year-old man with huge urate deposits and severe gouty arthropathy with underlying hypothyroidism. During the past years, he had undergone several surgeries with different degrees of amputation to remove the tophus. Magnetic resonance spectroscopy (MRS) of foot finger revealed high peak of lactate, suggesting that high lactate levels is linked with chronic gout and frequent attacks. The patient was treated with levothyroxine along with gout medication, and his thyroid-stimulating hormone (TSH) and urate levels were soon normal, suggesting that the underlying hypothyroidism had aggravated his gout condition.