Management of Thyroid Diseases and Steroid Replacement in Ramadan: A Review Study

Document Type : Review Article

Authors

1 Jinnah Hospital, Lahore

2 Shaukat Khanum Cancer Hospital and Research Center

Abstract

Most Muslims fast during the holy month of Ramadan. Patients with thyroid diseases do not normally need medication adjustment and are able to fast safely. On the other hand, hypothyroid patients are prescribed with thyroxine tablets, which should be taken on an empty stomach at bedtime or half an hour before Sohur. Hyperthyroid patients receiving treatment with methimazole or carbimazole have to adjust to 1-2 daily doses, while patients using propylthiouracil need to change their drug regimen. Severely symptomatic hyperthyroid patients require immediate treatment and must avoid fasting for a few days. Since adrenal insufficiency might be life-threatening, proper education is essential for these patients if they are willing to fast in Ramadan. In this regard, the educational content should be focused on the disease, proper medication, alarming signs and symptoms, sick day rules, dietary regimen, and physical activity.

Keywords

References

  1. Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R,Yarmohammadi L, et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J 2006;47:409-14.
  2. Mansi K, Masalmeh A. Impact of ramadan fasting on metabolism and on serum levels of some hormones among healthy Jordanian students.J Med Sci 2007;7:755-61.
  3. Ahmadinejad Z, Ziaee V, Rezaee M, Yarmohammadi L, Shaikh H,Bozorgi F, et al. The effect of ramadan fasting on thyroid hormone profile: A cohort study. Pak J Biol Sci 2006;9:1999-2002.
  4. Sajid KM, Akhtar M, Malik GQ. Ramadan fasting and thyroid hormone profile. J Pak Med Assoc 1991;41:213-6.
  5. Sherman SI, Tielens ET, Ladenson PW. Sucralfate causes malabsorption of L-thyroxine. Am J Med 1994;96:531-5.
  6. Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA 2000;283:2822-5.
  7. Campbell NR, Hasinoff BB, Stalts H, Rao B, Wong NC. Ferrous sulfate reduces thyroxine efficacy in patients with hypothyroidism.Ann Intern Med 1992;117:1010-3.
  8. Siraj ES, Gupta MK, Reddy SS. Raloxifene causing malabsorption of levothyroxine. Arch Intern Med 2003;163:1367-70.
  9. Liel Y, Harman-Boehm I, Shany S. Evidence for a clinically important adverse effect of fiber-enriched diet on the bioavailability of levothyroxine in adult hypo- thyroid patients. J Clin Endocrinol Metab 1996;81:857-7.
  10. Benvenga S, Bartolone L, Pappalardo MA, Russo A, Lapa D,Giorgianni G, et al. Altered intestinal absorption of L-thyroxine caused by coffee. Thyroid 2008;18:293-301.
  11. Fish LH, Schwartz HL, Cavanaugh J, Steffes MW, Bantle JP,Oppenheimer JH. Replacement dose, metabolism, and bioavailability of Levothyroxine in the treatment of hypothyroidism. N Engl J Med 1987;316:764-70.
  12. Bach-Huynh TG, Nayak B, Loh J, Soldin S, Jonklaas J. Timing of levothyroxine administration affects serum thyrotropin concentration.J Clin Endocrinol Metab 2009;94:3905-12.
  13. Bolk N, Visser TJ, Kalsbeek A, van Domburg RT, Berghout A. Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients. Clin Endocrinol (Oxf) 2007;66:43-8.
  14. Rajput R, Chatterjee S, Rajput M. Can levothyroxine be taken as evening dose? Comparative evaluation of morning versus evening dose of levothyroxine in treatment of hypothyroidism. J Thyroid Res 2011;2011:505239.
  15. Wilson P, Perdikis G, Hinder RA, Redmond EJ, Anselmino M, Quigley EM. Prolonged ambulatory antroduodenal manometry in humans.Am J Gastroenterol 1994;89:1489-95.
  16. Hays MT. Localization of human thyroxine absorption. Thyroid 1991;1:241-8.
  17. Stone E, Leiter LA, Lambert JR, Silverberg JD, Jeejeebhoy KN, Burrow GN. L-thyroxin absorption in patients with short bowel. J Clin Endocrinol Metab 1984;59:139-41.
  18. Keck ES, Wolf CF, Pfeiffer EF. The influence of circulating thyroxine serum concentration on hepatic thyroxine deiodinating activity in rats. Exp Clin Endocrinol 1990;96:269-77.
  19. Okamura Y, Shigemasa C, Tatsuhara T. Pharmacokinetics of methimazole in normal subjects and hyperthyroid patients. Endocrinol Jpn 1986;33:605-15.
  20. Schimmer BP, Parker KL. Adrenocorticotrophic hormone; adrenocortical steroids and their synthetic analogs; Inhibitors of the synthesis and actions of adrenocortical hormones. GOODMAN & GILMAN’S The Pharmacological Basis of Therapeutics. 11th ed., New Delhi: The McGraw Hill companies Inc.;2006. chap. 59,p1605.
  21. Cooper MS, Stewart PM. Current concepts: Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003;348:727-34.
  22. Debono M, Price JN, Ross RJ. Novel strategies for hydrocortisone replacement. Best Pract Res Clin Endocrinol Metab 2009;23:221- 32.
  23. Arafah BM Management of hormone replacement in Addison disease.2011 Meet –the – Professor, clinical case management. Maryland 20815, USA: Published by the endocrine society, 2011:page 37-41.
  24. Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA 2002;287:236-40.
  25. Stewart PM, Krone NP. The adrenal cortex. Williams Text Book of Endocrinology. 12th ed.,Philadelphia PA USA: ELSEVIER SAUNDERS, 2011 chap. 15, p.515-523.
Journal of Nutrition,Fasting and Health
Volume 4, Issue 2
June 2016
Pages 70-74

Files

History

  • Receive Date: 20 June 2016
  • Accept Date: 30 June 2016

Share

How to cite

Statistics