Abstract
Objective Thyroxine (T4) therapy is taken on an empty stomach and no food is taken for a short
period. During Ramadan fasting (RF), Muslim patients may face difficulties taking
levothyroxine as recommended.
Materials and Methods We performed a mixed methods study of an online survey of 218 physicians to explore
their perceptions and practices. Also, we interviewed a sample of 172 hypothyroid
patients to establish their practices and source of information. Their median age
was 46 (17–90) years; they had hypothyroidism for a median of 5 years and took a median
thyroxine dose of 100 µg daily. Furthermore, we attempted to explore the effects of
RF on available thyroid function tests.
Results Consultants were 58.4%, and the most represented specialty was endocrinology, 46.1%.
Regarding the impact of RF on T4 therapy, 52.3% thought the RF was not clinically
relevant in most patients on T4 replacement. However, 27.5% thought RF affects T4
replacement therapy in a clinically relevant manner. About 77.1% of respondents reported
giving advice routinely to all patients on T4 replacement during RF. One hundred sixty-four
respondents were split between recommending taking the medications with Iftar, Suhour, or other times. Most respondents (73.9%) do not repeat measurements of thyroid hormone
levels after Ramadan unless needed during their scheduled clinic visit. On the other
hand, 50.3% of the patients confirmed that their physician advised them to take their
thyroxine during Ramadan, whereas 40.4% could not recall receiving any advice. About
59.9% of the patients took thyroxine with Iftar, 23.8% with Suhour, and 16.3% at different times. In those patients where thyroid function tests were
available before and after RF, serum thyroid-stimulating hormone and serum-free T4
did not show a specific pattern in the group as a whole and with subgroups.
Conclusion There is variation in the advice that hypothyroid patients receive on taking thyroxine
during Ramadan and in their practices. Further studies are needed to determine the
best timing for thyroxine replacement.
Keywords
hypothyroidism - thyroxine replacement therapy - Ramadan fasting - Patients' perceptions
- Physicians' practices
