Comparison of Levothyroxine before Suhoor and after Iftar in Hypothyroid Patients Fasting During Ramdan on Thyroid Profile

Ahmad Usman; Uzma Malik; Sadeema Rahman; Waqar Ali; M. Nabeel Mohsin

doi:10.70749/ijbr.v3i7.2643

Authors

Ahmad Usman Department of East Medical Ward, King Edward Medical University (KEMU)/Mayo Hospital, Lahore, Punjab, Pakistan.
Uzma Malik Department of East Medical Ward, King Edward Medical University (KEMU)/Mayo Hospital, Lahore, Punjab, Pakistan.
Sadeema Rahman Department of East Medical Ward, King Edward Medical University (KEMU)/Mayo Hospital, Lahore, Punjab, Pakistan.
Waqar Ali Department of East Medical Ward, King Edward Medical University (KEMU)/Mayo Hospital, Lahore, Punjab, Pakistan.
M. Nabeel Mohsin Department of East Medical Ward, King Edward Medical University (KEMU)/Mayo Hospital, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i7.2643

Keywords:

Hypothyroidism, Levothyroxine, Ramadan Fasting, TSH, Suhoor, Iftar.

Abstract

Objectives: To compare levothyroxine before-suhoor and after-iftar in hypothyroid patients fasting during Radman on thyroid profile. Methodology: This study was conducted at Endocrinology outpatient department, three months including the month of Ramadan. A total of 90 hypothyroid patients aged 18–60 years who fasted during Ramadan were enrolled in this observational cohort study. Baseline and post-Ramadan thyroid profiles (TSH, fT3, fT4) were obtained. Participants chose to take levothyroxine either one hour before suhoor or one hour after iftar. Treatment compliance was assessed using the Morisky Medication Adherence Questionnaire. Results: No statistically significant differences were found between the suhoor and iftar groups in pre- or post-Ramadan TSH (p = 0.97, p = 0.96), fT3 (p = 0.34, p = 0.41), or fT4 (p = 0.52, p = 0.37) levels. A total of 39.96% of participants demonstrated good treatment adherence, while the remainder showed medium or poor compliance. Conclusion: Timing of levothyroxine intake—whether before suhoor or after iftar—did not significantly affect thyroid hormone levels in fasting hypothyroid patients. Emphasis on adherence and individualized dosing strategies may be more important than timing alone during Ramadan.

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References

1. Shah, N. (2021). Prevalence and manifestations of hypothyroidism among population of Hyderabad, Sindh, Pakistan. Pure and Applied Biology, 10(3).

https://doi.org/10.19045/bspab.2021-100069

2. Verma, D. P., Chaudhary, S. C., Singh, A., Sawlani, K. K., Gupta, K. K., Usman, K., Reddy, H. D., Patel, M. L., Verma, S. K., & Atam, V. (2024). Hypothyroidism in metabolic syndrome. Annals of African Medicine, 23(4), 717-722.

https://doi.org/10.4103/aam.aam_25_24

3. Javed, R. (2023). Incidence of thyroid diseases in local population. Pakistan Journal of Medical and Health Sciences, 17(1), 17-19.

https://doi.org/10.53350/pjmhs202317117

4. Hidayat, M. (2023). Factors responsible for the persistence of hypothyroidism among Pakistani women. Pakistan Journal of Medical Sciences, 40(1).

https://doi.org/10.12669/pjms.40.1.8446

5. KOCA, A. O., DAĞDEVİREN, M., & ALTAY, M. (2020). Should the dose of levothyroxine be changed in hypothyroidism patients fasting during Ramadan? TURKISH JOURNAL OF MEDICAL SCIENCES, 50(4), 784-788.

https://doi.org/10.3906/sag-1911-28

6. Hidayat, M. (2023). Factors responsible for the persistence of hypothyroidism among Pakistani women. Pakistan Journal of Medical Sciences, 40(1).

https://doi.org/10.12669/pjms.40.1.8446

7. Khan, S. A., Aftab, S., Khan, Y. N., Yasir, M., Arshad, K., Mehak, N. U., Rehman, S. K., Faiztalpur, A., Bahar, S., Abdul Razzaq, A., Habibullah, S., Naseem, A., Hussain, S. S., Sattar, H., Usman, M., Ayub, A., Waris, R., & Butt, T. A. (2024). A national survey on congenital hypothyroidism newborn screening in Pakistan. Global Pediatric Health, 11.

https://doi.org/10.1177/2333794x241293526

8. Hidayat, M. (2023). Factors responsible for the persistence of hypothyroidism among Pakistani women. Pakistan Journal of Medical Sciences, 40(1).

https://doi.org/10.12669/pjms.40.1.8446

9. Alzahrani, A. S., Al Mourad, M., Hafez, K., Almaghamsy, A. M., Alamri, F. A., Al Juhani, N. R., Alhazmi, A. S., Saeedi, M. Y., Alsefri, S., Alzahrani, M. D., Al Ali, N., Hussein, W. I., Ismail, M., Adel, A., El Bahtimy, H., & Abdelhamid, E. (2020). Diagnosis and management of hypothyroidism in Gulf Cooperation Council (GCC) countries. Advances in Therapy, 37(7), 3097-3111.

https://doi.org/10.1007/s12325-020-01382-2

10. Sheikh, A., Mawani, M., & Mahar, S. A. (2018). Impact of Ramadan fasting on thyroid status and quality of life in patients with primary hypothyroidism: A prospective cohort study from Karachi, Pakistan. Endocrine Practice, 24(10), 882-888.

https://doi.org/10.4158/ep-2018-0038

11. El-Kaissi, S., Dajani, R., Lee-St. John, T. J., Ann Santarina, S., Makia, F., AlTakruri, M., & Ahmed, Y. (2020). Impact of lifestyle changes during Ramadan on thyroid function tests in hypothyroid patients taking Levothyroxine. Endocrine Practice, 26(7), 748-753.

https://doi.org/10.4158/ep-2019-0505

12. Elsherbiny, T. M. (2023). Twice or thrice weekly levothyroxine provides similar rates of adherence and post-Ramadan euthyroidism compared to daily levothyroxine during Ramadan fasting. Thyroid Research, 16(1).

https://doi.org/10.1186/s13044-023-00187-z

13. Zaboon, I. A., Alidrisi, H. A., Hussein, I. H., Alabbood, M., Alibrahim, N. T., Almomin, A. M., Al-Waeli, D. K., Alhamza, A. H., Mohammed, A. G., Nwayyir, H. A., Al-Ali, A. J., & Mansour, A. A. (2020). Best time for Levothyroxine intake in Ramadan (THYRAM): Basrah experience. International Journal of Endocrinology and Metabolism, 18(2).

https://doi.org/10.5812/ijem.94325

14. Aljaberi, A., Alamoudi, R., Elsherbiny, T. M., Hafidh, K., Raza, S. A., & Beshyah, S. A. (2024). Thyroxine replacement therapy during Ramadan fasting: A narrative review. Journal of Diabetes and Endocrine Practice, 07(04), 156-167.

https://doi.org/10.1055/s-0044-1791485

15. Dellal F, Öğmen B, Özdemir D, Alkan A, Seyrek F, Polat Ş, et al. (2020). Effect of Ramadan fasting on thyroid hormone levels in patients on levothyroxine treatment. Journal of the College of Physicians and Surgeons Pakistan, 30.

http://doi.org/10.29271/jcpsp.2020.10.1009

16. Al-Mutawa, N., Mussa, B. M., Akhlaq, S., AbdulWahid, Z., & Qawas, A. (2025). Extra levothyroxine dose in Ramadan maintained normal thyroid hormone levels in patients with hypothyroidism: A randomized controlled trial. Frontiers in Endocrinology, 16.

https://doi.org/10.3389/fendo.2025.1513904

17. Ghaffar, T., Ahmad, I., & Bukhari, A. A. S. (2021). Effect of the timing of thyroxine intake on thyroid stimulating hormone levels in Ramadan. PJMHS, 15(01), 46-48.

18. Belal, M. M., Youssef, A. R., Baker, H., Elalaky, N. A., Marey, A. A., Quaisy, M. A., & Rabea, E. M. (2023). Effect of Ramadan fasting on thyroid functions in hypothyroid patients taking levothyroxine: A systematic review and meta-analysis. Irish Journal of Medical Science (1971 -), 193(2), 741-753.

https://doi.org/10.1007/s11845-023-03526-z

19. Oudghiri DM, Motaib I, Elamari S. (2022). Ramadan and hypothyroidism: Impact of Ramadan fasting on thyroid status. MEDICAL AND CLINICAL RESEARCH: OPEN ACCESS, 3(1).

https://doi.org/10.52106/2766-3213.1039

20. Mohammed, R. E., Mohamed, B. M., Reda, Y. A., Awaad, E. N., Baker, H., & Adel, M. Q. (2023). Thyroid hormone replacement during Ramadan fasting is a real challenge to hypothyroid patients. A systematic review and meta-analysis. Endocrine Abstracts.

https://doi.org/10.1530/endoabs.90.ep986

21. Alkaf, B., Siddiqui, M., Ali, T., Bakir, A., Murphy, K., Meeran, K., & Lessan, N. (2022). Ramadan fasting and changes in thyroid function in hypothyroidism: Identifying patients at risk. Thyroid, 32(4), 368-375.

https://doi.org/10.1089/thy.2021.0512