Best Time for Levothyroxine Intake in Ramadan (THYRAM): Basrah Experience

Ibrahim Abbood Zaboon; Haider Ayad Alidrisi; Ibrahim Hani Hussein; Majid Alabbood; Nassar Taha Yaseen Alibrahim; Ammar Mohammed Saeed Almomin; Dheyaa Kadhim Al-Waeli; Ali Hussein Ali Alhamza; Adel Gassab Mohammed; Hussein Ali Nwayyir; Ahmed Jaafer Hindi Al-Ali; Abbas Ali Mansour

doi:10.5812/ijem.94325

Best Time for Levothyroxine Intake in Ramadan (THYRAM): Basrah Experience

Int J Endocrinol Metab. 2020 Apr 6;18(2):e94325. doi: 10.5812/ijem.94325. eCollection 2020 Apr.

Affiliations

¹ Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC), Basrah Health Directorate, Basrah, Iraq.
² Department of Medicine, College of Medicine, University of Basrah, Basrah, Iraq.
³ Alzahraa College of Medicine, University of Basrah, Basrah, Iraq.
⁴ Department of Medicine, College of Medicine, University of Thi-Qar, Thi-Qar, Iraq.
⁵ Thi-Qar Diabetic, Endocine, and Metabolism Center (TDEMC), Thi-Qar Health Directorate, Thi-Qar, Iraq.

Abstract

Background: Fasting the month of Ramadan should be achieved by every pubescent Muslim unless they have an excuse. Fasting involves complete abstinence of oral intake throughout daytime. Patients who have hypothyroidism usually require levothyroxine (L-thyroxine) replacement, which is typically given on an empty stomach away from meals. Taking L-thyroxine replacement without feeding is challenging during the nighttime of Ramadan, in addition to being prohibited during daytime.

Objectives: This study aimed to determine the best time of L-thyroxine intake during Ramadan.

Methods: Fifty patients who were taking L-thyroxine treatment for primary hypothyroidism were involved in this prospective study for three months including the fasting and pre-fasting months. The patients were divided into three groups with different times of L-thyroxine intake. In the group one (pre-iftar), the patients were asked to take L-thyroxine at the time of iftar (the sunset meal) but to delay any oral intake for at least 30 minutes. In the group two (post-iftar), the patients were asked to take L-thyroxine two hours after iftar. The patients in the last group (pre-suhoor) were asked not to eat in the last two hours before suhoor (the predawn meal) and to take L-thyroxine tablet one hour prior to suhoor.

Results: When thyroid stimulating hormone (TSH) levels were compared before and after Ramadan, there were no significant differences neither within each group nor among all the study groups. Moreover, the frequencies of the TSH control after Ramadan showed no significant differences within each of the study groups (P = 0.18, 0.75, 1.0 for pre-suhoor, pre-iftar, and post-iftar respectively). Similarly, comparison among the groups of the study showed no significant differences regardless of whether the patients had controlled or uncontrolled TSH prior to Ramadan (P = 0.75 and 0.67, respectively). In the patients with controlled TSH before Ramadan, 8 out of 10 (pre-suhoor), 8 out of 12 (pre-iftar), and 4 out of 6 (post-iftar) maintained their control after Ramadan. While in the patients with uncontrolled TSH before Ramadan, 7 out of 10 (pre-suhoor), 6 out of 8 (pre-iftar), and 2 out of 4 (post-iftar) achieved controlled TSH after Ramadan.

Conclusions: No significant differences in TSH control were observed in patients taking L-thyroxine at pre-iftar, post-iftar, or pre-suhoor time in Ramadan.

Keywords: Fasting; Hypothyroidism; Ramadan; Thyroxine.