IMPACT OF RAMADAN FASTING ON THYROID STATUS AND QUALITY OF LIFE IN PATIENTS WITH PRIMARY HYPOTHYROIDISM: A PROSPECTIVE COHORT STUDY FROM KARACHI, PAKISTAN

Objective: 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. Methods: 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. Results: 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 mu g. On average, patients fasted for 26.5 days and missed a dose of LT4 on 1.27 days. Mean TSH pre-Ramadan was 237 +/- 135 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 mIUIL; 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. Conclusion: 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.