From the Research
Administration of Levothyroxine during Ramadan
- The administration of levothyroxine during Ramadan can be challenging for hypothyroid patients due to changes in meal timing 1.
- Studies have investigated the optimal timing of levothyroxine intake during Ramadan to minimize changes in thyroid function tests 2, 3, 4, 5.
- A systematic review and meta-analysis found that Ramadan fasting was associated with a significant increase in TSH levels in patients who were euthyroid before Ramadan, but free thyroxine (FT4) levels remained stable 1.
- A prospective randomized controlled trial found that instructing patients to take levothyroxine at the time of breaking the fast (30 minutes before the Iftar meal) minimized unfavorable changes in plasma TSH post-Ramadan 2.
- Another randomized clinical trial found that the timing of levothyroxine intake during Ramadan did not significantly affect TSH or FT4 levels, and patients could take levothyroxine either 30 minutes before Iftar or 3-4 hours after Iftar with no meal for 1 hour, depending on preference 3.
- A randomized controlled trial in patients with prior total thyroidectomy found that taking levothyroxine pre-iftar did not result in significant changes in TSH, whereas taking it post-iftar or pre-suhoor did 4.
- A prospective study found no significant differences in TSH levels or control among patients taking levothyroxine at pre-iftar, post-iftar, or pre-suhoor times during Ramadan 5.
Key Findings
- TSH levels may increase during Ramadan, regardless of the timing of levothyroxine intake 1, 2, 3, 4.
- The timing of levothyroxine intake may not significantly affect TSH or FT4 levels during Ramadan 3, 5.
- Patient preference and individual factors, such as age and weight gain, may influence the optimal timing of levothyroxine intake during Ramadan 2, 4.
Timing of Levothyroxine Intake
- Pre-iftar (30 minutes before the Iftar meal): may minimize unfavorable changes in plasma TSH post-Ramadan 2.
- Post-iftar (3-4 hours after the Iftar meal): may result in significant increases in TSH levels 2, 4.
- Pre-suhoor (1 hour before the Suhoor meal): may result in significant increases in TSH levels 4.
- No significant differences in TSH control were observed among patients taking levothyroxine at pre-iftar, post-iftar, or pre-suhoor times during Ramadan 5.