临床药师对1例妊娠甲状腺功能亢进患者的药学监护

Pharmaceutical Care for a Patient with Pregnancy Thyrotoxicosis by Clinical Pharmacists

目的:为妊娠甲状腺功能亢进患者用药提供参考。方法:临床药师通过参与妊娠甲状腺功能亢进患者治疗用药方案的制订,建议将富马酸比索洛尔片2.5 mg、qd、po,丙硫氧嘧啶50 mg、tid、po改为甲巯咪唑10 mg、qd、po,普萘洛尔10 mg、tid、po。结果:医师部分接受了药师的建议,改为甲巯咪唑10 mg、qd、po。2周后复查甲状腺功能较前改善,继续用药4周后甲状腺功能示血清游离三碘甲腺原氨酸(FT3)6.12 pmol/L、血清游离甲状腺素(FT4)22.61 pmol/L、促甲状腺激素(TSH)2.26μIU/ml,停用比索洛尔,甲巯咪唑改为5 mg、qd、po。继续用药1月后复查甲状腺功能FT3 5.5 pmol/L、FT4 20.97 pmol/L、TSH 2.63μIU/ml,停用甲巯咪唑。此后保持每4周定期复查甲状腺功能,均维持在正常范围,未再出现怕热多汗等症状,后自然分娩一健康女婴。结论:临床药师可通过规范的对症治疗改善妇女妊娠及胎儿的结局。

OBJECTIVE： To provide reference for drug use in patients with pregnancy thyrotoxicosis. METHODS： Clinical pharmacists participated in the formulation of drug therapy plan for patients with pregnancy thyrotoxicosis, and suggested that me- thidathion （10 mg, qd, po） and propranolol （10 mg, tid, po） to replac Bisoprolol fumarate tablet （2.5 mg, qd, po） and propyl- thiouracil （50 mg, tid, po）. RESULTS： Physicians accepted some suggestions of clinical pharmacists, i.e. methidathion （10 mg, qd, po）. The function of thyroid had been improved after 2 weeks of treatment. 4 weeks later, the function of thyroid was re- checked： FT3 6.12 pmol/L, FT4 22.61 pmol/L and TSH 2.26 μIU/ml. Bisoprolol therapy was discontinued, and the doses of methi- dathion changed into 5 mg, qd, po; 1 month later, the function of thyroid was rechecked： FT3 5.5 pmol/L, FT4 20.97 pmol/L and TSH 2.63 μIU/ml. Methidathion therapy was discontinued; the function of thyroid was rechecked every 4 weeks and kept in normal range; the symptoms as heat intolerance and sweating didn＇t occur again. The patient gave birth to a healthy baby girl naturally. CONCLUSIONS： Standard symptomatic treatment by clinical pharmacists can improve pregnancy outcome of woman and fetus.