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Cited by 15Thyroid Disorders and TreatmentsDietary Effects on HealthThyroid and Parathyroid Surgery

Optimal timing of thyroid hormone replacement during Ramadan fasting: a randomized controlled trial in patients with prior total thyroidectomy

Al-Qahtani, Khalid M., Aldeeri, Ibraheem Ahmed, Alshaibi, Amal M., Alshabib, Norah Salman, Barghouthi, Rakan M., Alyusuf, Ebtihal Y., Jammah, Anwar Ali·2022·Thyroid
DOI 10.1089/thy.2022.0110
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Abstract

Background: Fasting during Ramadan may be challenging for patients on levothyroxine (LT4), as the drug has a narrow therapeutic index and is administered on an empty stomach. The majority of Muslims who fast in Ramadan have two meals per day, iftar immediately after sunset and suhoor just before dawn. This study aimed at evaluating the impact of LT4 timing during Ramadan on thyrotropin (TSH) levels in patients who underwent total thyroidectomy to determine the best timing for intake and identify the predictors of TSH level changes. Methods: We conducted a parallel, double-blind, randomized controlled trial on Saudi patients diagnosed with hypothyroidism who underwent total thyroidectomy. Patients were required to have stable thyroid function for 6 months before the study period and fast ≥20 days of Ramadan. Participants were randomized to one of three times for LT4 administration: Group A, 30 minutes pre-iftar ( n = 48); Group B, 3 hours post-iftar ( n = 47); or Group C, 1 hour pre-suhoor ( n = 47). The number of participants in the final analysis (excluding patients who dropped out) was as follows: Group A, ( n = 31); Group B, ( n = 34); and Group C, ( n = 22). The changes in TSH and free thyroxine (fT4) levels two weeks before and after Ramadan were compared. Factors associated with a change in TSH levels were examined through multivariable analysis. Results: The TSH levels significantly increased in Group B (1.7 ± 1.8 mU/L vs. 3.1 ± 3.9 mU/L, p = 0.003) and Group C (2 ± 1.7 mU/L vs. 5.5 ± 10 mU/L, p = 0.011), but not Group A (1.8 ± 1.6 mU/L vs. 3.3 ± 4.2 mU/L, p = 0.158). The change in fT4 levels was comparable among the groups: Group A, 16.5 ± 2.7 mcg/dL vs. 15.9 ± 3.2 mcg/dL, p = 0.144; Group B, 15.8 ± 3.8 mcg/dL vs. 16.3 ± 3.6 mcg/dL, p = 0.620; and Group C, 17.5 ± 2.8 mcg/dL vs. 17.3 ± 3.9 mcg/dL, p = 0.770. In multivariable linear regression analysis, the following variables were significantly independently associated with TSH level change: age, weight gain, and the number of nonadherence days to LT4, where β = −0.2, p = 0.026; β = + 0.2, p = 0.026; and β = + 0.5, p < 0.0001, respectively. Conclusions: Fasting patients who took LT4 pre-iftar did not experience significant changes in TSH, whereas those who took LT4 post-iftar or pre-suhoor did. The TSH changes during Ramadan may be associated with age (inverse association), weight gain, and the number of non-adherence to LT4 days. Trial Registration: SCTR Application no. 21122002.

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Authors
Al-Qahtani, K. M., Aldeeri, I. A., Alshaibi, A. M., Alshabib, N. S., Barghouthi, R. M., Alyusuf, E. Y., & Jammah, A. A.
Affiliations
  • College of Medicine, King Saud University, Riyadh, Saudi Arabia.
  • King Saud University (SA)
Corresponding author
Jammah, Anwar Ali
ORCID
Venue
Thyroid
Publisher
SAGE Publications
Published
2022-09
Volume
32
Issue
9
Pages
1029-1036
ISSN
  • 1050-7256 (ISSN-L)
  • 1557-9077
DOI
10.1089/thy.2022.0110
OpenAlex
W4283008688
Cited by
15
References
23
Citations by year
2026: 3 · 2025: 5 · 2024: 3 · 2023: 4
FWCI
2.23
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Thyroid (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords
levothyroxine, drug timing, Ramadan fasting, total thyroidectomy, hypothyroidism, thyroid-stimulating hormone, free thyroxine, meal timing, iftar, thyroid hormone replacement, medication adherence, Saudi patients, body mass index, sex, diabetes mellitus, hypertension
MeSH terms
Fasting, Humans, Religion, Thyroid Hormones, Thyroidectomy, Thyrotropin, Thyroxine, Weight Gain, Hormone Replacement Therapy

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