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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2024; 07(04): 156-167
DOI: 10.1055/s-0044-1791485
Review Article

Thyroxine Replacement Therapy during Ramadan Fasting: A Narrative Review

Asma Aljaberi 
1   Department of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
2   Internal Medicine Department, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
,
Reem Alamoudi 
3   College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
4   King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
5   Department of Medicine, King Abdulaziz Medical City, Jeddah, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
,
Tamer M. Elsherbiny 
6   Endocrinology Unit, Alexandria Faculty of Medicine, Alexandria University, Khartoum Square, Azarita, Alexandria, Egypt
,
Khadija Hafidh 
7   Diabetes Unit, Department of Internal Medicine, Dubai Academic Health Corporation, Dubai, United Arab Emirates
8   Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
,
Syed Abbas Raza
9   Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
,
Salem A. Beshyah 
8   Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
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Abstract

Introduction Ramadan fasting-induced changes in eating and sleeping patterns pose a risk of influencing thyroid hormone levels. There is a recognition of the potential impact of fasting and feasting on levothyroxine (L-T4) absorption.

Materials and Methods A narrative, nonsystematic literature review from two major medical online databases (PubMed and Google Scholar) from their inception to the search day (February 22, 2024). A relevant combined search term was used. The retrieved literature is narrated in a concise account.

Results There is a relationship between metabolism and thyroid-stimulating hormone (TSH). This relationship contributes to transient metabolic disturbances that influence the pharmacodynamics and pharmacokinetics of various drugs, adding complexity to the management of hypothyroidism during Ramadan fasting. Several observational studies have studied the changes in thyroid function levels during unmodified L-T4 regimens. Experimental trials explored the impact on body weight, well-being, and thyroid functions when the timing of L-T4 administration changes. Findings are far from homogeneous due to different study protocols. A recent meta-analysis demonstrated a significant post-Ramadan increase in TSH levels among euthyroid patients. L-T4 timing points, encompassing pre-Iftar, post-Iftar, and pre-Suhoor, are associated with elevated TSH levels after Ramadan fasting. The emphasis on individualized L-T4 regimens during Ramadan fasting is underscored, with recommendations for patients to refrain from food for at least 3 hours before and 30 minutes after L-T4 intake to ensure optimal compliance by most experts. The association between adherence to L-T4 during Ramadan fasting and maintaining euthyroid status is highlighted, encouraging patients to follow prescribed regimens diligently. Modified dosing frequencies, such as weekly regimens, exhibit promising results, especially in patients grappling with compliance issues. Proactive consultations with physicians before Ramadan are needed to review the latest thyroid function test and make possible dose adjustments.

Conclusion Managing hypothyroidism during Ramadan necessitates an understanding of medication timing, food-drug interactions, and prior regimens. Adherence, facilitated by flexibility, plays a critical role in achieving euthyroid status.

Keywords

Ramadan fasting - thyroid - hypothyroid - levothyroxine - food-drug interaction

Authors' Contributions

S.A.B. proposed the study, performed the literature searches, and drafted the manuscript. All authors reviewed the document for intellectual content and approved its final version.


Financial Support and Sponsorship

None.


Compliance with Ethical Principles

No ethical approval is required.


Disclaimer

To the best of our abilities, we presented our perception of the published work in good faith. Original authors cannot be held responsible for any misrepresentation.




Publication History

Article published online:
30 September 2024

© 2024. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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