Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2026
Predawn Versus Preiftar Timing of Levothyroxine Administration During Ramadan Intermittent Fasting: A Multicenter Randomized Controlled Trial.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Alamoudi Reem M, Nawar Samah, Al Mulla Abdulrhman, Alharbi Hiba, Alqarni Ali, Alzahrani Abdullah M, Busaad Walaa, Alahmari Nasser, Alshamrani Nouf, Alkhalifa Lujain, Saleh Yousef, Ramadan Majed, Borai Anwar
Аннотация
OBJECTIVES: To compare 2 levothyroxine (LT4) dosing regimens during Ramadan: preiftar and predawn, with respect to thyroid biochemical control and patient satisfaction.
METHODS: This multicenter, open-label randomized controlled trial recruited adults with primary hypothyroidism from 3 Saudi cities (Jeddah, Riyadh, and Al-Ahsa). Patients with thyroid cancer were excluded. Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were measured 2 weeks before and 4 to 6 weeks after Ramadan. Participants were randomized to take LT4 either before breaking the fast (preiftar) or just before fasting began (predawn).
RESULTS: A total of 303 (156 preiftar and 147 predawn) participants completed the study. Groups were comparable in demographic characteristics and comorbidities. Mean age was 49 ± 12 years; 87% were female; mean disease duration was 9.7 ± 8.3 years. Weekly LT4 dose was 753 ± 349 μg (preiftar) versus 733 ± 266 μg (predawn; P = .001). Pre-Ramadan TSH level was 2.56 ± 2.16 mIU/L versus 2.46 ± 1.72 mIU/L (P = .3), and FT4 level was 13.45 ± 2.1 versus 13.08 ± 2.4 pmol/L (P = .16). Post-Ramadan TSH level was 3.64 ± 4.1 versus 4.07 ± 4.2 mIU/L (P = .78), and FT4 level was 12.96 ± 0.1 versus 12.64 ± 0.2 pmol/L (P = .003). Within-group post-Ramadan changes were nonsignificant. Repeated measures analysis of variance showed no significant differences in TSH or FT4 levels over time or between groups (P = .47 and P = .81). Compliance and satisfaction were comparable.
CONCLUSION: Both preiftar and predawn LT4 regimens maintained thyroid stability during Ramadan. Either can be safely adopted according to patient preference.
METHODS: This multicenter, open-label randomized controlled trial recruited adults with primary hypothyroidism from 3 Saudi cities (Jeddah, Riyadh, and Al-Ahsa). Patients with thyroid cancer were excluded. Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were measured 2 weeks before and 4 to 6 weeks after Ramadan. Participants were randomized to take LT4 either before breaking the fast (preiftar) or just before fasting began (predawn).
RESULTS: A total of 303 (156 preiftar and 147 predawn) participants completed the study. Groups were comparable in demographic characteristics and comorbidities. Mean age was 49 ± 12 years; 87% were female; mean disease duration was 9.7 ± 8.3 years. Weekly LT4 dose was 753 ± 349 μg (preiftar) versus 733 ± 266 μg (predawn; P = .001). Pre-Ramadan TSH level was 2.56 ± 2.16 mIU/L versus 2.46 ± 1.72 mIU/L (P = .3), and FT4 level was 13.45 ± 2.1 versus 13.08 ± 2.4 pmol/L (P = .16). Post-Ramadan TSH level was 3.64 ± 4.1 versus 4.07 ± 4.2 mIU/L (P = .78), and FT4 level was 12.96 ± 0.1 versus 12.64 ± 0.2 pmol/L (P = .003). Within-group post-Ramadan changes were nonsignificant. Repeated measures analysis of variance showed no significant differences in TSH or FT4 levels over time or between groups (P = .47 and P = .81). Compliance and satisfaction were comparable.
CONCLUSION: Both preiftar and predawn LT4 regimens maintained thyroid stability during Ramadan. Either can be safely adopted according to patient preference.