護理師正給予病人每日口服 75 mcg 左甲狀腺素（levothyroxine）。病人詢問是否可以與早上的綜合維他命一同服用。最佳的回應是什麼？
A nurse is administering levothyroxine 75 mcg PO daily. The client asks if they can take it with their morning multivitamin. What is the best response?
- ANo, you should take levothyroxine at least 4 hours apart from multivitamins.✓ 正解不行，您應將左甲狀腺素與綜合維他命至少間隔 4 小時服用。
- BYes, but only if the multivitamin does not contain calcium.可以，但前提是該綜合維他命不含鈣。
- CNo, take levothyroxine at bedtime.不行，請在睡前服用左甲狀腺素。
- DYes, taking them together will improve absorption.可以，同時服用會促進吸收。
左甲狀腺素（Levothyroxine）的吸收極易受到胃腸道內金屬陽離子（如鈣、鐵、鎂、鋁）的干擾。綜合維他命通常含有這些礦物質，會與藥物形成螯合物（chelation），嚴重降低藥物的生物利用度。為了確保甲狀腺素的穩定血中濃度，必須嚴格遵守服藥的時間間隔，這屬於病人教育中提升藥物療效的核心護理職責。
The absorption of levothyroxine is highly susceptible to interference from gastrointestinal metallic cations (such as calcium, iron, magnesium, and aluminum). Multivitamins typically contain these minerals, which form chelates with the medication and substantially reduce its bioavailability. To maintain stable serum thyroid hormone levels, the timing interval between doses must be strictly observed. This represents a core nursing responsibility in patient education to enhance medication efficacy.