# 情境 52歲新診斷原發性甲狀腺機能低下症的個案開始levothyroxine 50 mcg PO daily。哪個個案陳述顯示正確理解新處方?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375093&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 52歲新診斷原發性甲狀腺機能低下症的個案開始levothyroxine 50 mcg PO daily。哪個個案陳述顯示正確理解新處方?

## 選項

1. 「一旦我的症狀在幾週後改善，我就會停止服用藥物，因為甲狀腺會自行康復。」
2. 「我可以在每次續藥時，在品牌藥和學名藥之間切換，以降低藥費。」
3. 「我會在早上與我的鈣片和維生素D補充劑一起服用，因為這樣很方便，可以一次全部服用。」
4. 我會在早餐前30~60分鐘空腹、每天固定時間配一杯水服用。 **✔ 正確答案**

**正確答案: 4**

## 解析

Levothyroxine(Synthroid、Levoxyl)為甲狀腺荷爾蒙補充藥，需精確且穩定吸收。教學重點：(1) 每天固定時間早餐前30~60分鐘空腹配一杯水(或晚餐後4小時睡前)；(2) 與鈣、鐵、鎂、制酸劑、sucralfate、膽酸結合劑相隔至少4小時，避免吸收受阻；(3) 咖啡於1小時內亦會降低吸收，至少間隔1小時；(4) 甲狀腺機能低下通常終身需要服藥，症狀改善亦不可停藥；(5) 原廠藥與學名藥生體可用率不同，為穩定TSH建議維持同一品項，若換藥於6週後再驗TSH；(6) 報告心悸、震顫、怕熱、體重減輕、失眠(補充過量)及持續倦怠、怕冷、體重增加、便秘(補充不足)。懷孕需增量25~30%。

## 深入解析

選項2涵蓋吸收4原則(空腹、配水、固定時間、一致性)。鈣鐵結合為最常考的交互作用。

## 重要概念

- **levothyroxine** — T4荷爾蒙補充藥，空腹、終身服用，以TSH監測
- **absorption interaction** — 與鈣、鐵、制酸劑結合導致吸收下降，須相隔4小時
- **hypothyroidism** — TSH↑、T4↓，需終身荷爾蒙補充，懷孕時增量25-30%

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