General discussion is for non-gout. How’s your family? Where’s this year’s holiday (vacation)? What does the Donald mean to you? That sort of thing.
But this topic is seriously gouty.
Anyway, I can’t remember the medical history of every member. So, I forgot about your thalassemia. Sorry, d_q! My immediate suggestion is (but see my last paragraph first):
1. Get a pill cutter (UK Amazon link that will earn me about 5p if you use the link. So, don’t worry if you have a different source)
2. Start febuxostat as soon as pill-cutter arrives.
3. After 2-4 weeks get a uric acid blood test and the usual kidney function and liver function tests.
I realize it can be worrying to think about potential liver effects of febuxostat. But, it’s a rare occurrence. Medicine for complex cases is challenging. But, we’re lucky to live in an age with different options.
Finally, reading between the lines, am I right in thinking you are off allopurinol at the moment, d_q? If so, it might be a very good idea to get a 24-hour uric acid excretion test. Because, if your uric acid excretion rate is low, it can often be fixed with probenecid.