Levothyroxine Timing during Ramadan: A Randomized Clinical Trial.

Area of Science:

• Endocrinology
• Metabolic Disorders

Background:

• Levothyroxine is essential for lifelong hypothyroidism management.
• Ramadan fasting presents challenges for medication compliance, particularly levothyroxine administration.
• Optimizing levothyroxine intake timing during Ramadan is crucial for maintaining thyroid hormone balance.

Purpose of the Study:

• To investigate the effect of different levothyroxine administration times on thyroid-stimulating hormone (TSH) and free T4 (FT4) levels in hypothyroid patients during Ramadan.
• To assess patient compliance with various levothyroxine dosing schedules during the fasting period.

Main Methods:

• Hypothyroid patients were randomized into three groups based on levothyroxine intake timing relative to iftar meal.
• Thyroid function tests (TSH and FT4) were conducted before and after Ramadan.
• Mixed-effects analysis was used to identify factors influencing TSH and FT4 level changes.

Main Results:

• A statistically significant increase in both TSH and FT4 levels was observed after Ramadan.
• Levothyroxine administration timing (30 minutes before iftar vs. 3-4 hours after iftar) did not significantly affect TSH or FT4 levels.
• Patient compliance was lower when levothyroxine was taken 3-4 hours after iftar.

Conclusions:

• Despite significant increases in TSH and FT4 post-Ramadan, the timing of levothyroxine intake did not influence these levels.
• Hypothyroid patients can select their preferred levothyroxine timing (30 minutes before iftar or 3-4 hours after iftar) during Ramadan, ensuring at least one hour without food intake after the latter.
• Individual patient preference can guide levothyroxine administration timing during Ramadan fasting.