【病例学习第15期】Thyroid Replacement（甲状腺替代治疗）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

以下为正文(需要翻译的部分),欢迎会员认领并尽可能在48小时内翻译完毕并提交,将奖励50威望和50金钱.


Thyroid Replacement

TT is a 66-year-old woman with newly diagnosed hypothyroidism who comes to the pharmacy with her first prescription for levothyroxine 75 mcg daily and hands it to the pharmacist. The pharmacist pulls up TT?s medication profile and notes that she is taking aspirin 81 mg daily, clopidogrel 75 mg daily, atorvastatin 80 mg daily, and amlodipine 10 mg daily. When asked by the pharmacist, TT admits to having undergone coronary revascularization about 2 months ago after a bout of chest pain.

What concerns should the pharmacist have regarding TT?s new levothyroxine prescription?


ANSWER
Levothyroxine (T4) is the drug of choice for replacing thyroid hormone, because it is not associated with a high rate of allergic reactions and exhibits uniform potency. Whereas the average maintenance dose of levothyroxine ranges between 110 and 120 mcg/day, starting doses are typically far less. Although a younger healthy adult might start at a dose of 50 mcg/day, an older patient or one with coronary disease should be started at doses of 25 mcg/day and titrated upward by 25 mcg/day each month until a normal thyroid-stimulating hormone level is achieved (goal: 0.25-6.7 mIU/L). Such a titration scheme will decrease the risk of cardiac toxicity that can be associated with thyroid replacement therapy (heart failure, angina, myocardial infarction). Due to TT?s advanced age and history of cardiac disease, the pharmacist should call the prescriber to discuss a decrease in the levothyroxine dose.


以下为翻译后的内容感谢“路遥知马力”提供，欢迎大家对翻译结果进一步完善。

甲状腺替代治疗
TT是一名66岁的妇女，最近被诊断为甲减。她来到药房，拿着她的第一张处方“左旋甲状腺素片，75ug，Qd”，递给了药师。药师拒绝为TT调配该药，理由是她正在服用阿司匹林81mg/d、氯比格雷75mg/d、阿托伐他汀80mg/d和氨氯地平10mg/d。当接受药师询问的时候，TT承认大约2个月前在一次胸痛发作后，她进行了冠脉重建术。
那么药师对TT新开的左旋甲状腺素片处方应给予怎样的关注呢？

答案
左旋甲状腺素(T4)是替代甲状腺激素的药物，疗效确切且很少引起过敏反应，维持剂量通常为110～120ug/d，起始治疗剂量远小于此维持剂量。年轻的健康成人通常从50ug/d的剂量开始，年龄较大的患者或存在冠脉疾病的患者通常从25ug/d开始，并逐渐增加剂量（25ug/m）直到促甲状腺激素（TSH）的水平达到正常范围（0.25-6.7 mIU/L）。这样的给药方法能降低甲状腺替代治疗所致的心脏毒性，如心衰、心绞痛、心肌梗塞等发生的风险。由于TT年龄较大，而且有心脏病病史，药师应要求开方医生减少左旋甲状腺素的剂量。

您的翻译结果已经转到主题下（管理员注），欢迎其他会员修正翻译结果。

只是“titrated upward by 25 mcg/day each month ”这句似乎有点不好理解，请大家指点，谢谢！

我的理解: 滴定治疗,逐步加量, 每月加量25微克/天."an older patient or one with coronary disease should be started at doses of 25 mcg/day and titrated upward by 25 mcg/day each month until a normal thyroid-stimulating hormone level is achieved (goal: 0.25-6.7 mIU/L). "
意译: 开始剂量25微克/天, 一月后, 开始以25加25即50微克/天的剂量服用,再一个月,开始以50加25即75微克/天的剂量服用.直到TSH达标.

回复 5# 真定府


    呵呵，我理解也如此，因此译为25ug/m，也不知对否？