management of thyroid diseases and steroid replacement in ramadan: a review study

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.