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

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

doi:10.3906/sag-1911-28

Cited by 10 publications

(10 citation statements)

References 15 publications

(24 reference statements)

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“…Thyroxine absorption can be affected and lead to suboptimal control of hypothyroidism [33]. It has been proposed that the best time to take thyroxine is later at night provided that no additional heavy food is eaten between Iftar and the late night hours [34]. These recommendations have used Level 3 evidence and a Grade D by the IDF DAR writing group.…”

Section: Other Medical Considerations; Relevance To Ramadan Fasting A...mentioning

confidence: 99%

Diabetes and Ramadan: Practical guidelines 2021

Hassanein

Afandi

Ahmedani

et al. 2022

Diabetes Research and Clinical Practice

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Section: Other Medical Considerations; Relevance To Ramadan Fasting A...mentioning

confidence: 99%

Diabetes and Ramadan: Practical guidelines 2021

Hassanein

Afandi

Ahmedani

et al. 2022

Diabetes Research and Clinical Practice

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“…Furthermore, Or Koca et al investigated whether the dose of levothyroxine was changed during RF in 97 patients with a wide age range on a stable dose of LT4 for at least 6 months. 22 They demonstrated a significant increase in serum TSH levels after Ramadan but no significant change in serum-free thyroxine (fT4) levels. They suggested making a small increase in LT4 dose before Ramadan in some hypothyroid patients wishing to fast.…”

Section: Discussionmentioning

confidence: 96%

“…They suggested making a small increase in LT4 dose before Ramadan in some hypothyroid patients wishing to fast. 22…”

Section: Discussionmentioning

confidence: 99%

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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“…Therapeutically, small increases in levothyroxine dose by 25–50 μg/day from the beginning of Ramadan till 2–3 weeks post-Ramadan have been previously suggested to improve the control of hypothyroidism ( 11–16 ). However, the effect of this small increase in levothyroxine dose or the timing of its administration during Ramadan has not been evaluated in a prospective trial.…”

Section: Discussionmentioning

confidence: 99%

Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk

Alkaf

Siddiqui

Ali

et al. 2022

Thyroid

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Background: Ramadan fasting (RF) is associated with major changes in meal times. This can affect thyroxine absorption and thyroid function (TF) in patients with hypothyroidism. We aimed to examine the short- and long-term impact of RF on TF in patients with primary hypothyroidism on levothyroxine. Methods: TF tests in patients with primary hypothyroidism attending an endocrine center in the United Arab Emirates were retrospectively analyzed. The impact of RF on TF, namely serum thyrotropin (TSH) TSH, free thyroxine (fT4) and free triiodothyronine (fT3), was investigated in 481 patients within 3 months before Ramadan (BR), 1–2 weeks (PR1), and 3–6 months (PR2) post-Ramadan. Controlled TF was defined as TSH between 0.45 and 4.5 μIU/mL. Inadequate control was defined as TSH >4.5 μIU/mL. Loss of control was defined as having controlled TF at BR and inadequate control at PR1. Multivariable regression analyses were used to assess the association of baseline TSH, baseline levothyroxine dose, and medication use with loss of thyroid control in Ramadan. Results: TSH increased significantly from a median of 2.0 (0.8–3.7) μIU/mL at BR to 2.9 (1.4–5.6) μIU/mL at PR1 ( p < 0.001). This was accompanied by a fall in fT4 and fT3 at PR1 ( p < 0.001). 25.5% of patients with previously controlled TF at BR had deterioration in TF at PR1. Sixty-one percent of patients with previously uncontrolled TF at BR remained uncontrolled at PR1. Baseline TSH was significantly associated with loss of thyroid control in Ramadan with an odds ratio (95% confidence interval) of 1.5 (1.17–1.92) ( p < 0.001), whereas other variables, including medications known to affect levothyroxine absorption were not associated with loss of control. TSH, fT4, and fT3 levels returned to normal at PR2. Conclusions: RF can negatively affect TF of patients on levothyroxine replacement. Although this effect is modest and transitory in most patients, a significant minority exhibit more pronounced, and clinically relevant changes. The latter includes those with higher TSH BR, and a smaller group whose thyroid disease appears to be particularly affected by the mealtime and lifestyle changes of Ramadan.

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

Cited by 10 publications

References 15 publications

Diabetes and Ramadan: Practical guidelines 2021

Diabetes and Ramadan: Practical guidelines 2021

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

Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk

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