Clinical Thyroidology / Research Article

El-Kaissi S.a· AbdelWareth L.b· Dajani R.c· Lee-St. John T.J.d· Santarina S.A.d· Makia F.d· AlTakruri M.c· Kaskas A.E.R.e· Ahmed Y.c

Author affiliations

aDepartment of Endocrinology, Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
bDepartment of Laboratory Medicine, National Reference Laboratory and Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
cDepartment of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
dResearch Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
eDepartment of Patient Education, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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Article / Publication Details

First-Page Preview

Received: February 21, 2021
Accepted: June 02, 2021
Published online: August 10, 2021

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 4

ISSN: 2235-0640 (Print)
eISSN: 2235-0802 (Online)

For additional information: https://www.karger.com/ETJ

Abstract

Background and Aim: We have previously shown in a retrospective analysis that the plasma thyroid-stimulating hormone (TSH) rises significantly post-Ramadan in levothyroxine-treated hypothyroid patients, possibly as a result of lifestyle alterations and time restrictions during the nonfasting period from dusk until dawn. The aim of this study is to determine the best time to instruct patients to take levothyroxine during Ramadan so as to minimize changes in thyroid function tests during this period. Methods: In a randomized prospective design, hypothyroid patients taking levothyroxine were randomized to receive instructions to take levothyroxine at one of the following 3 times during Ramadan: (group 1) at dusk 30-min before Iftar meal, (group 2) 3 or more hours after Iftar meal, or (group 3) at dawn 30-min before Suhur meal. Thyroid function tests were performed within 3 months before Ramadan and within 6 weeks post-Ramadan. Data from patients with at least 1 blood test before or after Ramadan were analyzed using mixed-effects regression models. Results: Plasma TSH levels were available at one or more time points for 148 patients, group 1 (n = 50), group 2 (n = 46), and group 3 (n = 52). A statistically significant within-patient increase in plasma TSH was seen in patients at the 25th percentile pre-Ramadan in groups 2 and 3 (p values <0.001), but not in group 1. A statistically significant within-patient decrease in plasma TSH was found in patients at the 75th percentile in group 1 only. For patients at the 50th percentile pre-Ramadan, no statically significant within-patient changes were found, though descriptively, increases in plasma TSH were observed for groups 2 and 3, while a decrease was observed in group 1. Conclusions: Our data suggest that instructing patients to take levothyroxine at the time of breaking the fast 30 min before the Iftar meal minimizes unfavorable changes in plasma TSH post-Ramadan. In contrast, instructing patients to take levothyroxine 3 h post-Iftar or 30 min before Suhur led to a greater rise in post-Ramadan TSH.

© 2021 European Thyroid Association Published by S. Karger AG, Basel

References Sajid KM, Akhtar M, Malik GQ. Ramadan fasting and thyroid hormone profile. J Pak Med Assoc. 1991 Sep;41(9):213–6. Karoli R, Fatima J, Chandra A, Mishra PP. Levothyroxine replacement and Ramadan fasting. Indian J Endocrinol Metab. 2013 Mar;17(2):318–9. Sheikh A, Mawani M, Mahar SA. Impact of ramadan fasting on thyroid status and quality of life in patients with primary hypothyroidism: a Prospective Cohort Study from Karachi, Pakistan. Endocr Pract. 2018 Oct 2;24(10):882–8. Dabbous Z, Alowainati B, Darwish S, Ali H, Farook S, Al Malaheem M, et al. A prospective study comparing two-time points of thyroid hormone replacement during the holy month of ramadan. Int J Endocrinol. 2019;2019:9843961. El-Kaissi S, Dajani R, Lee-St John TJ, Ann Santarina S, Makia F, AlTakruri M, et al. Impact of lifestyle changes during ramadan on thyroid function tests in hypothyroid patients taking levothyroxine. Endocr Pract. 2020;26(7):748–53. Fish LH, Schwartz HL, Cavanaugh J, Steffes MW, Bantle JP, Oppenheimer JH. Replacement dose, metabolism, and bioavailability of levothyroxine in the treatment of hypothyroidism. Role of triiodothyronine in pituitary feedback in humans. N Engl J Med. 1987 Mar 26;316(13):764–70. Wenzel KW, Kirschsieper HE. Aspects of the absorption of oral L-thyroxine in normal man. Metabolism. 1977 Jan;26(1):1–8. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014 Dec;24(12):1670–751. Rogosa D, Saner H. Longitudinal data analysis examples with random coefficient models. J Educ Behav Stat. 1995 Jun 1;20(2):149–70. Bolk N, Visser TJ, Kalsbeek A, van Domburg RT, Berghout A. Effects of evening vs. morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin Endocrinol. 2007 Jan;66(1):43–8. Article / Publication Details

First-Page Preview

Received: February 21, 2021
Accepted: June 02, 2021
Published online: August 10, 2021

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 4

ISSN: 2235-0640 (Print)
eISSN: 2235-0802 (Online)

For additional information: https://www.karger.com/ETJ

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