Endocr Pract. 2018 Oct 2;24(10):882-888. doi: 10.4158/EP-2018-0038. Epub 2018 Jul 5.
Ramadan is the ninth month in the lunar calendar, during which Muslims fast from predawn to sunset and major changes occur in their dietary, sleep, and physical activity patterns. Most patients with hypothyroidism are unable to comply with the proper timings of levothyroxine (LT4) administration. The objective of the study was to determine the change in thyroid-stimulating hormone (TSH) level and quality of life (QOL) before and after Ramadan in patients with primary hypothyroidism.
This prospective cohort study included adult patients on stable doses of LT4 who fasted for at least 20 days during the month of Ramadan in the Islamic year 1437 Hijri (June/July 2016). Baseline characteristics and TSH levels were recorded on all consenting patients within 6 weeks prior to Ramadan. Post-Ramadan TSH was tested within 1 to 2 weeks after Eid-ul-Fitr.
During the study period, 64 patients with hypothyroidism were enrolled, of which 58 were female. The mean age of participants was 44.2 ± 13.2 years. Average daily dose of LT4 was 95.3 ± 35.4 μg. On average, patients fasted for 26.5 days and missed a dose of LT4 on 1.27 days. Mean TSH pre-Ramadan was 2.37 ± 1.35 mIU/L, and post-Ramadan, it was 4.69 ± 3.87 mIU/L. Mean difference between TSH pre- and post-Ramadan was 2.32 ± 3.80 mIU/L ( P<.001). However, the difference in TSH was not significantly different between those who were compliant with meals and LT4 interval versus those who were not (compliant, 2.04 mIU/L; noncompliant, 3.15 mIU/L; P = .30). Overall, an increase in QOL scores in the domains of physical health, psychological health, and social relationships was observed after Ramadan.
We observed statistically significant changes in TSH concentrations after the month of Ramadan in hypothyroid patients who fasted. The change in TSH was not affected by timing of LT4 intake and interval from meal.
AKUH = Aga Khan University Hospital; LT4 = levothyroxine; QOL = quality of life; TSH = thyroid-stimulating hormone.
斋月是农历的第九个月，在此期间，穆斯林从黎明前到日落后禁食，饮食、睡眠和体育活动模式发生重大变化。大多数甲状腺功能减退症患者无法遵守左甲状腺素（LT4）的正确给药时间。本研究的目的是确定在 1437 希吉拉年（2016 年 6 月/7 月）斋月期间禁食至少 20 天的原发性甲状腺功能减退症患者在斋月前后的促甲状腺激素（TSH）水平和生活质量（QOL）变化。
这项前瞻性队列研究纳入了在伊斯兰教历 1437 年（2016 年 6 月/7 月）斋月期间至少禁食 20 天且正在服用稳定剂量 LT4 的成年患者。在斋月前的 6 周内，所有同意的患者均记录了基线特征和 TSH 水平。斋月后 1 至 2 周内检测 TSH。
在研究期间，共纳入 64 例甲状腺功能减退症患者，其中 58 例为女性。参与者的平均年龄为 44.2±13.2 岁。LT4 的平均日剂量为 95.3±35.4μg。平均斋戒 26.5 天，漏服 LT4 1.27 天。斋月前的平均 TSH 为 2.37±1.35mIU/L，斋月后的平均 TSH 为 4.69±3.87mIU/L。斋月前后 TSH 的平均差值为 2.32±3.80mIU/L（P<.001）。然而，与饮食和 LT4 间隔符合要求的患者相比，不遵守要求的患者的 TSH 差异无统计学意义（符合要求者为 2.04mIU/L；不符合要求者为 3.15mIU/L；P=0.30）。总体而言，在斋月后观察到身体、心理和社会关系健康领域的 QOL 评分增加。
我们观察到在斋戒的甲状腺功能减退症患者中，TSH 浓度在斋月后有统计学意义的变化。LT4 摄入时间和与餐点的间隔对 TSH 的变化没有影响。
AKUH = Aga Khan 大学医院；LT4 = 左甲状腺素；QOL = 生活质量；TSH = 促甲状腺激素。
