Should the dose of levothyroxine be changed in hypothyroidism patients fasting during Ramadan?

Koca, Arzu Or; Dağdeviren, Murat; Altay, Mustafa

doi:10.1530/endoabs.63.p378

Cited by 2 publications

(11 citation statements)

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“…[14][15][16]. No recommendations exist for optimal L-T4 timing during the fasting month of Ramadan [17][18][19][20][21]. Only few studies explored the effect of fasting Ramadan on thyroid status in euthyroid and hypothyroid individuals [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…The included patients range from 47 to 97 patients. Four studies had a prospective design, while the fifth study was a retrospective one [17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…The tested timings for L-T4 administration during Ramadan are as follows: 2 h after meal at bedtime [17], 2 h after meal and 30 min before the next meal [18], a comparison between 30 min before iftar versus 30 min before suhor [19], a comparison between 30 min before iftar versus 2 h after iftar versus 1 h before suhor after 1 h of empty stomach [20], and finally, a comparison between at iftar versus at suhor [21]. None of these regimens follow the principles of the ATA or ETA evidence-based recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…None of these regimens follow the principles of the ATA or ETA evidence-based recommendations. We may conclude that the choice of these regimens or timings was based mainly on what is convenient, feasible, or accepted by the patients, rather than what is physiologic or recommended based on the available literature [17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Based on these observations, both the American Thyroid Association (ATA) and the European Thyroid Association (ETA) recommend that L-T4 be taken after awakening from sleep -on empty stomach by defaultand 60 min before breakfast, or for those who have an early evening meal, at least 3-4 h after the last meal and before going to sleep [14][15][16]. Few studies with a limited number of patients have reported the effect of fasting during Ramadan on thyroid function in Muslim hypothyroid patients treated with L-T4 following L-T4 intake regimens that do not comply with the current recommendations by the ATA and ETA and do not guarantee optimal L-T4 absorption [17][18][19][20][21]. The present study aimed to evaluate preference, adherence, and maintenance -or attainment -of euthyroidism using 3 different regimens of administering L-T4, regimens that fulfill the 2 conditions recommended by the ATA: first, to take the L-T4 tablet at least 3-4 h after the last meal and second, to take the tablet 60 min before the next meal or beverages, during the holy month of Ramadan in fasting hypothyroid patients in Egypt.…”

Section: Introductionmentioning

confidence: 99%

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

Elsherbiny¹

2021

Dubai Diabetes Endocrinol J

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Introduction: 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. Methods: 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. Results: 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 (p = 0.225). Adherence was predicted post-Ramadan euthyroidism (odds ratio [OR] 2.8 in univariate and OR 2.96 in multivariate models). Conclusions: 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.

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Section: Discussionmentioning

confidence: 99%

“…The included patients range from 47 to 97 patients. Four studies had a prospective design, while the fifth study was a retrospective one [17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Elsherbiny¹

2021

Dubai Diabetes Endocrinol J

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Thyroxine Replacement Therapy during Ramadan Fasting: Physicians' and Patients' Perceptions and Practices

Beshyah

Khalil

Beshyah

et al. 2023

Journal of Diabetes and Endocrine Practice

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Background Thyroxine (T4) therapy is taken on an empty stomach and no food is taken for a short period. During Ramadan fasting (RF), Muslim patients may face difficulties taking levothyroxine as recommended. Participants and Methods We performed a mixed methods study of an online survey of 218 physicians to explore their perceptions and practices. Also, we interviewed a sample of 172 hypothyroid patients to establish their practices and source of information. Their median age was 46 (17–90) years; they had hypothyroidism for a median of 5 years and took a median thyroxine dose of 100 µg daily. Furthermore, we attempted to explore the effects of RF on available thyroid function tests. Results Consultants were 58.4%, and the most represented specialty was endocrinology, 46.1%. Regarding the impact of RF on T4 therapy, 52.3% thought the RF was not clinically relevant in most patients on T4 replacement. However, 27.5% thought RF affects T4 replacement therapy in a clinically relevant manner. About 77.1% of respondents reported giving advice routinely to all patients on T4 replacement during RF. One hundred sixty-four respondents were split between recommending taking the medications with Iftar, Suhour, or other times. Most respondents (73.9%) do not repeat measurements of thyroid hormone levels after Ramadan unless needed during their scheduled clinic visit. On the other hand, 50.3% of the patients confirmed that their physician advised them to take their thyroxine during Ramadan, whereas 40.4% could not recall receiving any advice. About 59.9% of the patients took thyroxine with Iftar, 23.8% with Suhour, and 16.3% at different times. In those patients where thyroid function tests were available before and after RF, serum thyroid-stimulating hormone and serum-free T4 did not show a specific pattern in the group as a whole and with subgroups. Conclusions There is variation in the advice that hypothyroid patients receive on taking thyroxine during Ramadan and in their practices. Further studies are needed to determine the best timing for thyroxine replacement.

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Should the dose of levothyroxine be changed in hypothyroidism patients fasting during Ramadan?

Cited by 2 publications

References 0 publications

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

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

Thyroxine Replacement Therapy during Ramadan Fasting: Physicians' and Patients' Perceptions and Practices

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