A Randomized Clinical Trial Comparing 2 Levothyroxine Regimens During Ramadan Fasting in Thyroidectomized Patients

Area of Science:

• Endocrinology
• Internal Medicine
• Pharmacology

Background:

• Levothyroxine (L-T4) management during Ramadan fasting presents challenges for Muslim patients.
• Optimal L-T4 intake strategies to maintain euthyroidism during Ramadan are not well-established.

Purpose of the Study:

• To compare two practical approaches for L-T4 administration in Muslim patients observing Ramadan fast.
• To evaluate the impact of different L-T4 intake strategies on thyroid-stimulating hormone (TSH) levels.

Main Methods:

• A randomized study involving 69 patients with differentiated thyroid cancer on stable L-T4 doses.
• Arm A: L-T4 taken with the evening meal. Arm B: Increased L-T4 dose (25-50 µg) taken with the evening meal.

Main Results:

• At Ramadan's end, Arm B showed significantly lower mean TSH levels (1.67 ± 2.6 mU/L) compared to Arm A (5.6 ± 6.0 mU/L) (P = .0001).
• Arm B achieved desirable TSH levels (euthyroidism or subclinical hyperthyroidism) in 86% of patients, versus 60.6% in Arm A (P = .005).
• More subclinical hypothyroidism occurred in Arm A, while subclinical hyperthyroidism was more prevalent in Arm B.

Conclusions:

• A modified L-T4 dosing strategy (Arm B) appears preferable for maintaining optimal TSH levels during Ramadan.
• This approach may be particularly beneficial for differentiated thyroid cancer patients requiring TSH suppression.