Timing of Thyroxine Dose In Ramadan

Study Overview
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Brief Summary
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A Randomized trial comparing two different timing of taking thyroxine in patients with Hypothyroidism during fasting the month of Ramadan.

Detailed Description
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To date there is debate regarding the best timing of L-thyroxine administration during Ramadan as sufficient evidence is lacking. This study aims to compare two-time points of levothyroxine intake during Ramadan focusing on change in TSH, satisfaction and compliance. A prospective, randomized, open label, multicenter Study. The first group will be will be instructed to take their L-thyroxin dose as per current guidlines at breaking of fast time (sunset) with sip of water then wait 30-60 minutes to consume Iftar meal. The second group (pre-Fajer prayer), patients are going to be instructed to take L-thyroxin dose immediately before start of fast, i.e. Alfajer (dawn) regardless of Suhoor time. The values of Thyroid stimulating hormone (TSH) will be measured two weeks before Ramadan, and 2-4 weeks after Ramadan for comparison.

Official Title
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Timing of Thyroxine Dose In Ramadan; a Randomized Control Trial

Conditions
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Hypothyroidism

Intervention / Treatment
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* Other: L-Thyroxine time B (5-15 minutes Before dawn)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Saudi patient (males and female) above 18 years with Primary hypothyroidism on levothyroxine replacement who are willing to fast during Ramadan. Patients with controlled thyroid function for last 3 months on same dose of levothyroxine. Exclusion Criteria: Pregnant or lactating women. Uncontrolled thyroid function test three months prior Ramadan. Thyroid cancer patients who require suppressed TSH. Central Hypothyroidism, patient with acute illness. Patients diagnosed with malabsorption i.e., Celiac Disease, Short bowel, Bariatric surgeries Use of certain Medications like systemic glucocorticoids, activated charcoal, sucralfate, aluminum hydroxide antacid, bile acid sequestrants, iron, calcium carbonate, PPI, rifampicin, and antiepileptic medications Renal or hepatic disease: Creatinine clearance <0.6 ml/s or serum creatinine ≥200 μmol/l Alanine transferase ≥2.5 times the upper limit of normal Active liver disease including jaundice, chronic hepatitis, previous liver transplant Unwillingness to be randomized or to sign informed consent Known Psychiatric Disorders Known uncontrolled substance abuse or alcoholism

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Pre-Iftar (Breaking the fast)<br>To take thyroxine at breaking of fast with sip of water then wait 30-60 miuntes to eat iftar (breakfast). | Other: L-Thyroxine time B (5-15 minutes Before dawn)<br>* Taking thyroxine at two different time points in relation to fasting and food intake; just before dawn and start of fast compared to the usual timing of 30-60minutes after the sunset breakfast meal.<br>|
| Experimental: Pre-Fajr (Starting the fast)<br>To take thyroxine immediately before start of fast at predawn time regardless of last meal time. | Other: L-Thyroxine time B (5-15 minutes Before dawn)<br>* Taking thyroxine at two different time points in relation to fasting and food intake; just before dawn and start of fast compared to the usual timing of 30-60minutes after the sunset breakfast meal.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Thyroid function | Change in TSH level | 6 - 8 weeks |