{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:43:34Z","timestamp":1790351014831,"version":"4.1.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ramadan fasting (RF) is associated with major changes in meal times. This can affect thyroxine absorption and thyroid function (TF) in patients with hypothyroidism. We aimed to examine the short- and long-term impact of RF on TF in patients with primary hypothyroidism on levothyroxine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>TF tests in patients with primary hypothyroidism attending an endocrine center in the United Arab Emirates were retrospectively analyzed. The impact of RF on TF, namely serum thyrotropin (TSH) TSH, free thyroxine (fT4) and free triiodothyronine (fT3), was investigated in 481 patients within 3 months before Ramadan (BR), 1\u20132 weeks (PR1), and 3\u20136 months (PR2) post-Ramadan. Controlled TF was defined as TSH between 0.45 and 4.5\u2009\u03bcIU\/mL. Inadequate control was defined as TSH &gt;4.5\u2009\u03bcIU\/mL. Loss of control was defined as having controlled TF at BR and inadequate control at PR1. Multivariable regression analyses were used to assess the association of baseline TSH, baseline levothyroxine dose, and medication use with loss of thyroid control in Ramadan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      TSH increased significantly from a median of 2.0 (0.8\u20133.7) \u03bcIU\/mL at BR to 2.9 (1.4\u20135.6) \u03bcIU\/mL at PR1 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). This was accompanied by a fall in fT4 and fT3 at PR1 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). 25.5% of patients with previously controlled TF at BR had deterioration in TF at PR1. Sixty-one percent of patients with previously uncontrolled TF at BR remained uncontrolled at PR1. Baseline TSH was significantly associated with loss of thyroid control in Ramadan with an odds ratio (95% confidence interval) of 1.5 (1.17\u20131.92) (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas other variables, including medications known to affect levothyroxine absorption were not associated with loss of control. TSH, fT4, and fT3 levels returned to normal at PR2.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>RF can negatively affect TF of patients on levothyroxine replacement. Although this effect is modest and transitory in most patients, a significant minority exhibit more pronounced, and clinically relevant changes. The latter includes those with higher TSH BR, and a smaller group whose thyroid disease appears to be particularly affected by the mealtime and lifestyle changes of Ramadan.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2021.0512","type":"journal-article","created":{"date-parts":[[2022,2,12]],"date-time":"2022-02-12T07:28:12Z","timestamp":1644650892000},"page":"368-375","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Ramadan Fasting and Changes in Thyroid Function in Hypothyroidism: Identifying Patients at Risk"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7421-3055","authenticated-orcid":false,"given":"Budour","family":"Alkaf","sequence":"first","affiliation":[{"name":"Research Department, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsin","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Research Department, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomader","family":"Ali","sequence":"additional","affiliation":[{"name":"Research Department, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bakir","sequence":"additional","affiliation":[{"name":"Research Department, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Murphy","sequence":"additional","affiliation":[{"name":"Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Meeran","sequence":"additional","affiliation":[{"name":"Section of Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader","family":"Lessan","sequence":"additional","affiliation":[{"name":"Research Department, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,4,11]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1601899"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu11051192"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000081076"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7469.778"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.5812\/ijem.13(2)2015.29248"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.3109\/07435808809032986"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0860"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2014.0028"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X687493"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP-2018-0038"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.3906\/sag-1911-28"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.5812\/ijem.94325"},{"key":"e_1_3_6_14_2","first-page":"213","article-title":"Ramadan fasting and thyroid hormone profile","volume":"41","author":"Sajid KM","year":"1991","unstructured":"Sajid KM, , Akhtar M, , Malik GQ. 1991. Ramadan fasting and thyroid hormone profile. J Pak Med Assoc, 41:213\u2013216.","journal-title":"J Pak Med Assoc"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.4103\/2230-8210.109700"},{"key":"e_1_3_6_16_2","first-page":"55","article-title":"Ramadan fasting and thyroid hormone levels in women with hypothyroidism","volume":"8","author":"Pakdel R","year":"2020","unstructured":"Pakdel R, , Mohebbi M, , Rezaie N, , Hadjzadeh M-A-R. 2020. Ramadan fasting and thyroid hormone levels in women with hypothyroidism. J of Nutr Fast Health, 8:55\u201360.","journal-title":"J of Nutr Fast Health"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/9843961"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.plabm.2018.e00098"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1159\/000517706"},{"key":"e_1_3_6_20_2","unstructured":"Time and Date . Abu Dhabi Abu Dhabi United Arab Emirates\u2014sunrise sunset and daylength. 2021. 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