Predawn Versus Preiftar Timing of Levothyroxine Administration During Ramadan Intermittent Fasting: A Multicenter...

Area of Science:

• Endocrinology
• Metabolic Disorders
• Pharmacology

Background:

• Primary hypothyroidism requires consistent levothyroxine (LT4) management.
• Ramadan fasting presents challenges for medication timing, potentially impacting thyroid hormone levels.
• Optimizing LT4 dosing during Ramadan is crucial for patient well-being and adherence.

Purpose of the Study:

• To compare the efficacy of two LT4 dosing schedules during Ramadan: pre-Iftar versus pre-Dawn.
• To assess thyroid biochemical control (TSH, FT4) and patient satisfaction with each regimen.
• To provide evidence-based recommendations for LT4 management during intermittent fasting.

Main Methods:

• A multicenter, open-label randomized controlled trial was conducted with adult hypothyroid patients.
• Participants were randomized to take LT4 either before Iftar (breaking fast) or pre-Dawn (before fasting).
• Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were measured before and after Ramadan.

Main Results:

• 303 participants completed the study, with comparable demographics and comorbidities across groups.
• No significant differences in post-Ramadan TSH or FT4 levels were observed between the pre-Iftar and pre-Dawn LT4 groups.
• Within-group changes in thyroid hormones were non-significant, indicating stability with both regimens.

Conclusions:

• Both pre-Iftar and pre-Dawn LT4 dosing regimens are equally effective in maintaining thyroid stability during Ramadan.
• Either dosing strategy can be safely implemented, allowing for patient preference.
• These findings support flexible LT4 management for hypothyroid patients observing Ramadan.