The Ramadan Dilemma: When Should Hypothyroid Patients Take Their Levothyroxine?
DOI:
https://doi.org/10.62438/tunismed.v104i08.6417Keywords:
Hypothyroidism, Levothyroxine, Ramadan, Fasting, Treatment adherenceAbstract
Introduction: Primary hypothyroidism management presents unique challenges during Ramadan fasting. The administration of levothyroxine, which requires an empty stomach, must be adapted to the limited time window for meals. The aim of this study was to identify the most suitable timing for levothyroxine administration during Ramadan and to evaluate the impact of fasting on Thyroid Stimulating Hormone (TSH) levels.
Methods: This was a quasi-experimental study conducted during Ramadan of the Hijir year 1442 (1442 AH). Patients with primary hypothyroidism, who were euthyroid on stable therapy, were divided into two groups based on their preferred intake time: Group A took their treatment at Iftar
(just after sunset, 30 minutes before eating), and Group B took it at Suhur (before sunrise, at least three hours after the last meal and 30 minutes before the next). TSH levels were measured before (T0) and two weeks after Ramadan (T1).
Results: Thirty-nine patients were included (18 in Group A, 21 in Group B). A statistically significant increase in TSH levels from T0 to T1 was observed only in Group A (Iftar intake). However, the overall change in TSH was not significantly different between the two groups. Poor adherence to the recommended time interval between medication and meal intake was significantly higher in Group A. In a multivariate analysis, the number
of days not fasted and weight change were significantly associated with a TSH variation of 2 µUI/mL.
Conclusion: This study did not identify a single optimal timing ...( abstract truncated at 250 words).
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References
Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical Practice Guidelines for Hypothyroidism in
Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr
Pract. nov 2012;18(6):988-1028.
Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the Treatment of Hypothyroidism: Prepared by
the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 1 déc 2014;24(12):1670-751.
Girerd X, Hanon O, Anagnostopoulos K, Ciupek C, Mourad JJ, Consoli S. Evaluation de l’observance du traitement antihypertenseur
par un questionnaire: mise au point et utilisation dans un service spécialisé. Presse Med. 2001;30(21):1044-8.
Karoli R, Fatima J, Chandra A, Mishra P. Levothyroxine replacement and Ramadan fasting. Indian J Endocrinol Metab. 2013;17(2):318.
Bolk N, Visser TJ, Kalsbeek A, Van Domburg RT, Berghout A. Effects of evening vs morning thyroxine ingestion on serum thyroid
hormone profiles in hypothyroid patients. Clin Endocrinol (Oxf). janv 2007;66(1):43-8.
Hossain S, Banerjee M, Mondal S, Maiti A. A comparative study on effect of evening versus morning intake of levothyroxine in patients
of hypothyroidism. Thyroid Res Pract. 2018;15(2):89.
Rajput R, Chatterjee S, Rajput M. Can Levothyroxine Be Taken as Evening Dose? Comparative Evaluation of Morning versus Evening
Dose of Levothyroxine in Treatment of Hypothyroidism. J Thyroid Res. 2011;2011:1-5.
Skelin M, Lucijanić T, Liberati-Čizmek AM, Klobučar SM, Lucijanić M, Jakupović L, et al. Effect of timing of levothyroxine administration
on the treatment of hypothyroidism: a three-period crossover randomized study. Endocrine. nov 2018;62(2):432-9.
Bach-Huynh TG, Nayak B, Loh J, Soldin S, Jonklaas J. Timing of Levothyroxine Administration Affects Serum Thyrotropin
Concentration. J Clin Endocrinol Metab. 1 oct 2009;94(10):3905-12.
de Mello RB, Giassi K, Stahl G, Machado Assis ML, Flores MS, de Lima BC, et al. Evaluation of Bedtime vs. Morning Levothyroxine Intake to Control Hypothyroidism in Older Patients: A Pragmatic Crossover Randomized Clinical Trial. Front Med. 23 juin 2022;9:828762.
Ahmadineja Z, . VZ, . MR, . LY, . HS, . FB, et al. The Effect of Ramadan Fasting on Thyroid Hormone Profile: A Cohort Study. Pak J Biol Sci.1 mai 2006;9(10):1999-2002.
Sajid KM, Akhtar M, Malik GQ. Ramadan fasting and thyroid hormone profile. JPMA J Pak Med Assoc. sept 1991;41(9):213-6.
Belal MM, Youssef AR, Baker H, Elalaky NA, Marey AA, Quaisy MA, et al. Effect of Ramadan fasting on thyroid functions in hypothyroid patients taking levothyroxine: a systematic review and meta- analysis. Ir J Med Sci 1971 -. avr 2024;193(2):741-53.
Sheikh A, Mawani M, Mahar SA. Impact of Ramadan Fasting on Thyroid Status and Quality of Life in Patients with Primary
Hypothyroidism: a Prospective Cohort Study from karachi, pakistan. Endocr Pract. oct 2018;24(10):882-8.
Zaboon IA, Alidrisi HA, Hussein IH, Alabbood M, Alibrahim NTY, Almomin AMS, et al. Best Time for Levothyroxine Intake in Ramadan
(THYRAM): Basrah Experience. Int J Endocrinol Metab [Internet]. 6 avr 2020 [cité 27 oct 2021];18(2). Disponible sur: https://sites.
kowsarpub.com/ijem/articles/94325.html
Pakdel R, Mohebbi M, Rezaie N, Hadjzadeh MAR. Ramadan Fasting and Thyroid Hormone Levels in Hypothyroid Women. J Nutr Health [Internet]. sept 2019 [cité 1 nov 2021];(Online First). Disponible sur: https://doi.org/10.22038/jnfh.2019.42779.1217
Dellal FD. Effect of Ramadan Fasting on Thyroid Hormone Levels in Patients on Levothyroxine Treatment. J Coll Physicians Surg Pak. 1 oct 2020;30(10):1009-14.
Elsherbiny TM. Impact of fasting on thyrotropin and thyroid status during Ramadan in 292 previously well controlled hypothyroid
patients. IFTAR study. Endocrine. 7 nov 2022;79(3):484-90.
Al-Qahtani KM, Aldeeri IA, Alshaibi AM, Alshabib NS, Barghouthi RM, Alyusuf EY, et al. Optimal Timing of Thyroid Hormone Replacement During Ramadan Fasting: A Randomized Controlled Trial in Patients with Prior Total Thyroidectomy. Thyroid. 1 sept
;32(9):1029-36.
Dabbous Z, Alowainati B, Darwish S, Ali H, Farook S, Al Malaheem M, et al. A Prospective Study Comparing Two-Time Points of Thyroid Hormone Replacement during the Holy Month of Ramadan. Int J Endocrinol. 22 juill 2019;2019:1-5.
Liu G, Liang L, Bray GA, Qi L, Hu FB, Rood J, et al. Thyroid hormones and changes in body weight and metabolic parameters in response to weight loss diets: the POUNDS LOST trial. Int J Obes. juin 2017;41(6):878-86.
Ghaffar T, Ahmad I, Bukhari AAS. Effect of the Timing of Thyroxine Intake on Thyroid Stimulating Hormone Levels in Ramadan.
A. Irving S, Vadiveloo T, Leese GP. Drugs that interact with levothyroxine: an observational study from the Thyroid
Epidemiology, Audit and Research Study ( TEARS ). Clin Endocrinol (Oxf). janv 2015;82(1):136-41.
El-Kaissi S, AbdelWareth L, Dajani R, Lee-St. John TJ, Santarina SA, Makia F, et al. Levothyroxine Administration during Ramadan: A
Prospective Randomized Controlled Trial. Eur Thyroid J. 10 août 2021;1-6.
Mahzari M, Al Remthi F, Ajwah I, Al Hazmi M, Moafa W, Al Shahrani A, et al. Levothyroxine Timing during Ramadan: A Randomized
Clinical Trial. Falhammar H, éditeur. Int J Endocrinol. 10 févr 2023;2023:1-7.
Elsherbiny TM. Preference, Adherence, and Maintenance of Euthyroidism Using 3 Different Regimens of Levothyroxine Intake
during the Fasting Month of Ramadan. Dubai Diabetes Endocrinol J. 2021;27(1):6-13.
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