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Levothyroxine Administration during Ramadan: A Prospective Randomized Controlled Trial.

Samer El-Kaissi1, Laila AbdelWareth2, Ruba Dajani3

  • 1Department of Endocrinology, Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.

European Thyroid Journal
|December 27, 2021
PubMed
Summary
This summary is machine-generated.

Taking levothyroxine 30 minutes before Iftar during Ramadan minimizes thyroid-stimulating hormone (TSH) changes in hypothyroid patients. Other timings, like post-Iftar or pre-Suhur, led to greater TSH fluctuations.

Keywords:
FastingHypothyroidismLevothyroxineRamadanThyroid

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Pharmacology

Background:

  • Previous studies indicated increased plasma TSH in levothyroxine-treated hypothyroid patients post-Ramadan.
  • Lifestyle changes and time-restricted eating during Ramadan may influence thyroid function.

Purpose of the Study:

  • To determine the optimal timing for levothyroxine administration during Ramadan.
  • To minimize alterations in thyroid function tests (TFTs) in hypothyroid patients.

Main Methods:

  • A randomized prospective study involving 148 hypothyroid patients on levothyroxine.
  • Patients were assigned to take levothyroxine at dusk (Group 1), 3+ hours post-Iftar (Group 2), or at dawn (Group 3).
  • Thyroid function tests were measured before and after Ramadan; data analyzed using mixed-effects regression models.

Main Results:

  • Group 1 (dusk) showed no significant within-patient TSH increase, and a decrease at the 75th percentile.
  • Groups 2 (post-Iftar) and 3 (dawn) exhibited significant TSH increases at the 25th percentile.
  • Descriptive analysis showed TSH increases in Groups 2 and 3, and a decrease in Group 1 at the 50th percentile.

Conclusions:

  • Taking levothyroxine 30 minutes before Iftar (dusk) is recommended to minimize TSH changes during Ramadan.
  • Administering levothyroxine 3 hours post-Iftar or 30 minutes before Suhur resulted in higher post-Ramadan TSH levels.