Impact of fasting on thyrotropin and thyroid status during Ramadan in 292 previously well controlled hypothyroid patients. IFTAR study

Abstract

Purpose Fasting during Ramadan affects thyrotropin both in healthy subjects and hypothyroid patients on adequate levothyroxine replacement. Few studies have addressed this effect in hypothyroid patients with pre-Ramadan euthyroidism. This study aims to report the impact of fasting in a relatively large cohort. Methods This was a prospective study including hypothyroid patients who fasted Ramadan during the years 2018, 2019, and 2020 in Alexandria, Egypt. All patients were euthyroid. Patients chosen one of three levothyroxine regimens during Ramadan, regimen 1: 60 min before Iftar, regimen 2: 3–4 h after Iftar, 60 min before Suhor, regimen 3: before the start of next fast, 3–4 h after an early Suhor. Thyroid status was assessed in pre-Ramadan visit and reassessed in post-Ramadan visit within 6 weeks from the end of Ramadan. Results The study included 292 hypothyroid patients. Most patients were adherent, 249 patients (85.3%), one sixth of patients were non-adherent, 43 patients (14.7%). Post-Ramadan TSH was 2.13 ± 1.88 mIU/L versus 1.60 ± 0.96 mIU/L pre-Ramadan [P = 0.001]. Most patients were still euthyroid post-Ramadan, 233 patients (79.8%), while 59 patients (20.2%) were dysthyroid. Post-Ramadan TSH significantly correlated to pre-Ramadan TSH [P < 0.001]. Post-Ramadan TSH was significantly higher in non-adherent patients, 3.57 ± 3.11 mIU/L compared to adherent patients, 1.88 ± 1.44 mIU/L [P < 0.001]. Conclusion Fasting Ramadan in well controlled hypothyroid patients resulted in a significant increase in post-Ramadan TSH, yet 80% the patients remain euthyroid after Ramadan. Post-Ramadan TSH and euthyroidism are related to adherence and pre-Ramadan TSH.

Thyroxine Replacement Therapy during Ramadan Fasting: Physicians' and Patients' Perceptions and Practices

“…Elsherbiny studied the impact of fasting on thyrotropin and thyroid status during RF in 292 previously well-controlled hypothyroid patients (IFTAR study). 21 RF resulted in a significant increase in post-Ramadan TSH, yet 80% of the patients remained euthyroid after Ramadan, suggesting that post-Ramadan TSH and euthyroidism are related to adherence and pre-Ramadan TSH. El-Kaissi et al retrospectively examined the adherence to levothyroxine, eating patterns, and levothyroxine administration concerning meal times during Ramadan in 112 fasting hypothyroid patients.…”

“…Recently, several studies explored the impact of fasting on thyroid replacement therapy, dose adjustment, and timing of the LT4 intake. [16][17][18][19][20][21][22][23][24] However, how much of this information is translated into clinical practice and patients' day-to-day behavior has yet to be established. Therefore, exploring physicians' and patients' knowledge, attitudes, and practices is very timely.…”