# 情境 60歲穩定服用levothyroxine 100 mcg每天早晨的個案因缺鐵性貧血新開ferrous sulfate 325 mg BID。最能維持甲狀腺荷爾蒙吸收的護理指示為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375094&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 60歲穩定服用levothyroxine 100 mcg每天早晨的個案因缺鐵性貧血新開ferrous sulfate 325 mg BID。最能維持甲狀腺荷爾蒙吸收的護理指示為何?

## 選項

1. 在早餐時服用levothyroxine，然後在午餐時服用ferrous sulfate，以將它們分開服用。
2. 將levothyroxine和ferrous sulfate一起在早餐時服用，以簡化早晨的例行程序並提高服藥遵從性。
3. 起床時用水服用levothyroxine，ferrous sulfate於至少4小時後於午餐或晚餐服用。 **✔ 正確答案**
4. 在服用鐵劑期間停用levothyroxine，並在一個月後貧血得到矯正後再重新開始服用。

**正確答案: 3**

## 解析

鐵、鈣、鎂、制酸劑、sucralfate、cholestyramine等膽酸結合劑、PPI均經由螯合或改變胃pH降低levothyroxine吸收。標準處置為相隔至少4小時，levothyroxine仍維持原本空腹早晨的服藥時程。停用甲狀腺荷爾蒙會導致嚴重甲狀腺機能低下且非缺鐵治療之選擇。研磨僅在吞嚥困難時可考慮，混入鐵劑會破壞分離策略。新增相互作用藥物後6週應再驗TSH，吸收變化可能使TSH偏離目標範圍而需調整劑量。

## 深入解析

對穩定的levothyroxine療法新增吸收阻礙藥物時，4小時分離是共通解答。變更後務必再評估TSH。

## 重要概念

- **ferrous sulfate** — 口服鐵劑，空腹吸收佳但GI副作用，與levothyroxine相隔4h
- **4-hour separation** — 吸收阻礙藥物與levothyroxine間至少間隔4小時的原則
- **TSH recheck** — 劑量、併用、懷孕等變動後6週再驗TSH，正常0.4~4.0 mIU/L

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