Effect of Ramadan fasting on thyroid functions in hypothyroid patients taking levothyroxine: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: The major changes in the timing of meals during Ramadan may be challenging for hypothyroid patients on levothyroxine. We aimed to study the effect of Ramadan fasting on thyroid functions in hypothyroid patients taking levothyroxine. METHODS: We did a comprehensive search of 8 databases for Randomized controlled studies (RCTs) and observational studies investigating the effect of Ramadan fasting on thyroid functions in hypothyroid individuals taking levothyroxine. Relevant data was extracted and analyzed. Mean difference (MD) and standard deviation (SD) were used to evaluate the continuous data. Risk ratios (RR) with a 95% confidence interval were used for outcomes constituting dichotomous data. National Institutes of Health (NIH) tools were used to assess the risk of bias. RESULTS: Fourteen studies met our inclusion criteria, 3 RCTs, and 11 observational studies, all designed as pre-post studies. Ramadan fasting was associated with a statistically significant increase in TSH in patients who were euthyroid before Ramadan (MD = -0.76 [95% CI; -1.27, -0.25]). However, free thyroxine (FT4) was found to be stable (MD = 0.01, [95% CI; -0.03, 0.06]). All timing points were associated with a significant increase in TSH levels after Ramadan, pre-iftar (MD = -0.69 [95% CI; -1.03, -0.36]), post-iftar (MD = -0.76 [95% CI; -1.12, -0.39]), and pre-suhoor (MD = -1.19 [95% CI; -2.18, -0.19]). CONCLUSION: TSH increases significantly after Ramadan. No timing point has superiority in maintaining thyroid control. However, choosing the timing should be individualized according to the patient's preference to guarantee the most possible compliance.
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TSH changes during Ramadan may be associated with age (inverse association), weight gain, and number of non-adherence to LT4 days.
“The TSH changes during Ramadan may be associated with age (inverse association), weight gain, and the number of non-adherence to LT4 days (61).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [61]
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- Authors
- Belal, M. M., Youssef, A. R., Baker, H., Elalaky, N. A., Marey, A. A., Quaisy, M. A., & Rabea, E. M.
- Affiliations
- Alexandria University (EG)
- Corresponding author
- Rabea, Eslam Mohammed
- ORCID
- Venue
- Irish Journal of Medical Science (1971 -)
- Published
- 2023-09-21
- Volume
- 193
- Issue
- 2
- Pages
- 741-753
- ISSN
- 0021-1265 (ISSN-L)
- 1863-4362
- PMC
- PMC10961289
- OpenAlex
- W4386910923
- Cited by
- 10
- References
- 37
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 2
- FWCI
- 0.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Irish Journal of Medical Science (1971 -) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greater South Information System
- Funders
- Alexandria University
- Topics
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- Ramadan fasting, hypothyroidism, levothyroxine, thyroid function, thyroid-stimulating hormone, free thyroxine, meal timing, iftar, medication adherence
- MeSH terms
- Fasting, Humans, Hypothyroidism, Islam, Thyroid Gland, Thyrotropin, Thyroxine
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