Preference, Adherence, and Maintenance of Euthyroidism Using 3 Different Regimens of Levothyroxine Intake during the Fasting Month of Ramadan

Abstract

<b><i>Introduction:</i></b> Millions of Muslim hypothyroid patients fast during Ramadan. Limited data are available on the effect of fasting during Ramadan and different levothyroxine (L-T4) timings on thyroid status. The present study aimed to report preference, adherence, and maintenance of euthyroidism using 3 different regimens of L-T4 intake during Ramadan. <b><i>Methods:</i></b> This is a prospective study including Muslim hypothyroid patients fasting during Ramadan between 2018 and 2019. Patients freely chose between 3 regimens, regimen 1: to take L-T4 at sunset and postpone food and beverages for 60 min; regimen 2: to have iftar (first meal) at sunset, stop food and beverages for 3–4 h, have L-T4, and wait for 60 min before suhor (last meal); regimen 3: have suhor at midnight, stop food and beverages for 3–4 h, and have L-T4 before next fast. Thyroid status was assessed before and within 6 weeks after Ramadan. <b><i>Results:</i></b> 393 patients were included. The first 2 regimens or a combination of both was the most preferred by patients 40.5, 36.7, and 17%, respectively. 323/393 patients were adherent to L-T4 regimens (82.2%). 273/393 patients were euthyroid after Ramadan (69.5%). TSH pre- and post-Ramadan were 4.35 ± 12.30 mIU/L and 2.73 ± 3.37 mIU/L, respectively, with no statistically significant change (<i>p</i> = 0.225). Adherence was predicted post-Ramadan euthyroidism (odds ratio [OR] 2.8 in univariate and OR 2.96 in multivariate models). <b><i>Conclusions:</i></b> The first and second regimens or a combination of both was preferred by most patients. High rates of adherence and post-Ramadan euthyroidism were observed. Adherence to the preferred regimen is the main determinant of post-Ramadan euthyroidism.

Twice or thrice weekly versus daily thyroxine in hypothyroid fasting ramadan: A pilot study

“…Post-Ramadan euthyroidism rate of 74% was previously reported by our institution in Ramadan 2018 and 2019 using the same L-T4 regimens used in the present study. [ 12 ] Sheikh et al . [ 14 ] and El-Kaissi et al .…”

“…An adherence rate of 82% was previously reported by our institution in Ramadan 2018 and 2019 using the same L-T4 regimens used in the present study. [ 12 ] Karoli et al . [ 5 ] reported that only 25% of their patients adhered to stopping food 2 h before bedtime L-T4 dosing, while Sheikh et al .…”

“…Patients from both groups were free to follow one of three L-T4 regimens during Ramadan, explained in detail previously. [ 12 ] In short, regimen 1: to take L-T4 60 min before Iftar and beverages, regimen 2: to take L-T4 3–4 h after Iftar, 60 min before Suhor meal, regimen 3: to take L-T4 before the start of next fast 3-4 h after an early Suhor at midnight. If patients mixed between regimens 1 and 2, this was labeled regimen 4.…”

Impact of fasting on thyrotropin and thyroid status during Ramadan in 292 previously well controlled hypothyroid patients. IFTAR study

“…Patients were free to follow one of three L-T4 regimens during Ramadan, explained in detail previously [ 6 ]. In short, regimen 1: to take L-T4 60 min before Iftar and beverages, regimen 2: to take L-T4 3–4 h after Iftar, 60 min before Suhor meal, regimen 3: to take L-T4 before the start of next fast 3–4 h after an early Suhor around midnight.…”

“…Fasting Ramadan entails abstaining from food and drinks from dawn – more than an hour before sunrise – till sundown. In Egypt, years 2018 and 2019, duration of fasting ranged from 15 h:02 min to 15 h:29 min and 14 h:44 min to 15 h:23 min respectively, leaving only 9 h or less for 2 main meals and L-T4 intake for hypothyroid patients [ 6 ].…”