The Ramadan Dilemma: When Should Hypothyroid Patients Take Their Levothyroxine?

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Published Sep 13, 2026
https://doi.org/10.62438/tunismed.v104i08.6417
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Vol. 104 No. 08 (2026): Tunis Med Aug 2026

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Manel Jemel
National Institute of Nutrition and food technology, University of Tunis El Manar, Tunis, Tunisia
Elyes Kammoun
University Hospital Rabta, University of Tunis El Manar, Tunis, Tunisia
Maroua Chiboub
National Institute of Nutrition and food technology, University of Tunis El Manar, Tunis, Tunisia
Hajer Kandara
National Institute of Nutrition and food technology, University of Tunis El Manar, Tunis, Tunisia
Ines Kammoun
National Institute of Nutrition and food technology, University of Tunis El Manar, Tunis, Tunisia

Abstract

Introduction: Primary hypothyroidism management presents unique challenges during Ramadan fasting. The administration of levothyroxine, which requires an empty stomach, must be adapted to the limited time window for meals. The aim of this study was to identify the most suitable timing for levothyroxine administration during Ramadan and to evaluate the impact of fasting on Thyroid Stimulating Hormone (TSH) levels.
Methods: This was a quasi-experimental study conducted during Ramadan of the Hijir year 1442 (1442 AH). Patients with primary hypothyroidism, who were euthyroid on stable therapy, were divided into two groups based on their preferred intake time: Group A took their treatment at Iftar
(just after sunset, 30 minutes before eating), and Group B took it at Suhur (before sunrise, at least three hours after the last meal and 30 minutes before the next). TSH levels were measured before (T0) and two weeks after Ramadan (T1).
Results: Thirty-nine patients were included (18 in Group A, 21 in Group B). A statistically significant increase in TSH levels from T0 to T1 was observed only in Group A (Iftar intake). However, the overall change in TSH was not significantly different between the two groups. Poor adherence to the recommended time interval between medication and meal intake was significantly higher in Group A. In a multivariate analysis, the number
of days not fasted and weight change were significantly associated with a TSH variation of 2 µUI/mL.
Conclusion: This study did not identify a single optimal timing ...( abstract truncated at 250 words).

Keywords:

Hypothyroidism, Levothyroxine, Ramadan, Fasting, Treatment adherence

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