Sir my age is 31 yrs. and my esr is 40 and both feet s ankle swelling and small gouts on tibia, round the ankle and painful, when i goes to bed then swelling goes down and relief in pain, in day hour s when i am seating on chair and do my work or 2-3 hours in standing position the swelling increased. my TSH is 7.15, T4 is 4.14, T3 is 0.87 and TPO is 282.1. kindly advised me for treatment thanks and what is the reason of thyroid increasing.