患者老年男性，因“甲巯咪唑口服不耐受，已行放射性碘治疗6月”就诊，存在甲状腺功能亢进症疗效与不良反应的矛盾，结合患者意愿，临床采用甲巯咪唑乳膏局部外用的治疗方案。12周的随诊中，患者症状明显缓解，甲状腺功能明显改善，且血常规和肝功能未出现明显异常。该病例在用药选择上打破常规思维，结合药物效应动力学、药物代谢动力学理论基础和医师临床经验摸索制定甲巯咪唑乳膏初始量和减药量，亦为此制剂用药提供临床参考意见。

An elderly male patient sought medical attention due to "intolerance of methimazole tablet and radioiodine treatment for six months". There was a contradiction between the efficacy and adverse drug reaction. Based on the patient′s wishes, the clinical treatment of methimazole cream was adopted. During the follow-up of 12 weeks, the patient′s symptoms were significantly improved, the indicators of thyroid function declined to normal level, and there were no significant abnormalities in indicators for routine blood test and liver function. The case broke away from conventions in medication selection, showing that the initial and reduced dosage was explored and formulated by combination of the theoretical basis of pharmacodynamics, pharmacokinetics and physician′s clinical experience. It also provided clinical reference for the use of the topical formulation.