Twice or Thrice Weekly versus Daily Thyroxine in Hypothyroid Fasting Ramadan: A Pilot Study

Hypothyroid patients require to take levothyroxine (L-T4) on an empty stomach, 60 min before next meal which is difficult to achieve while fasting Ramadan, on a daily basis. This pilot study aimed to assess the effect of twice or thrice weekly versus standard daily L-T4 dosing during Ramadan on adherence, post-Ramadan TSH, and thyroid status.

The study included 2 groups; group 1 included 11 patients assigned to take L-T4 twice or thrice a week, and group 2 included 113 patients assigned to take L-T4 daily. Patients chose between three L-T4 regimens: regimen 1 - 60 min before Iftar; regimen 2 - 60 min before Suhor, on empty stomach for 3-4 h; regimen 3 - before the next fast, on empty stomach for 3-4 h. Thyroid status was assessed before and within 6 weeks after Ramadan. Only euthyroid patients were included.

No significant differences between the two groups regarding adherence, post-Ramadan TSH, or post-Ramadan thyroid status. 90.9% in group 1 and 88.5% in group 2 were adherent [p = 1.000]. Post-Ramadan TSH in group 1 was 1.9 ± 1.5 mIU/L, in group 2 was 2 ± 1.6 mIU/L [p = 0.809]. 81.8% in group 1 and 82.3% in group 2 were euthyroid post-Ramadan [p = 0.209].

In this pilot study, taking L-T4 twice or thrice weekly during Ramadan achieved similar adherence and metabolic control to standard daily L-T4, making it an easier option for hypothyroid patients wishing to fast Ramadan.