Pre-bed dosing of L-thyroxine in Ramadan and the effect on lipid parameters

• Main Authors: Zakaria, Nurul Aulia, Shahar, Mohammad Arif
• Format: Conference or Workshop Item
• Language: English; English
• Published: 2019
• Subjects: RC648 Specialties of Internal Medicine-Diseases of The Endocrine Glands. Clinical Endocrinology
• Online Access: http://irep.iium.edu.my/81836/1/KRD%20ThyRa%20Lipid.pdf; http://irep.iium.edu.my/81836/7/krd2019.pdf; http://irep.iium.edu.my/81836/

INTRODUCTION :Pre-bed dosing of L-thyroxine is an alternative method to improve patient’s compliance especially in the month of Ramadan. However some studies reported the increment of Thyroid Stimulating Hormone (TSH) on Pre-bed dosing suggesting Subclinical Hypothyroidism(SH). Dyslipidemia is one of the marker for tissue hypothyroidism. However, the relationship between Subclinical Hypothyroidism (SH) and lipid metabolism is still debatable.OBJECTIVE :We would like to investigate the effect of Pre-bed thyroxine ingestion during the month of Ramadan towards thyroid hormones and lipid parameters. METHOD : A total of 9 hypothyroid patients who are on daily L-thyroxine replacement (taken before breakfast) with a normal baseline thyroid hormones and lipid profile were involved in this study. During Ramadan, they were asked to take their daily dose of L-thyroxine pre-bed instead of taking it pre-breakfast. At the end of Ramadan, their thyroid hormones and lipid profile were analysed. RESULTS : Most of the patients were already on thyroxine for more than a year with a stable dose of L-thyroxine . Their thyroid hormones (TSH,fT3,fT4) and lipid profile (TC, LDL, HDL,triglyceride) were within normal range at presentation. At the end of Ramadan, there was a significant increment of TSH observed [TSH w0 1.8(0.23,5.57) vs w4 3.65(0.45,16.10) p=0.011] without significant change of fT3 and fT4 which indicate SH. However , there were no significant change in the lipid parameters at the end of Ramadan despite biochemically being SH. CONCLUSION :Pre bed dosing biochemically showed to cause Subclinical Hypothyroidsim(SH).However, no effect on lipid metabolism were observed to indicate tissue hypothyroidism in SH.