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Importantly, all GLP-1 receptor agonists carry a boxed warning about the risk of thyroid C-cell tumors and are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2

Abbreviations T2D: Type 2 diabetes CVD: Cardiovascular disease MASLD: Metabolic dysfunction-associated steatotic liver disease WAT: White adipose tissue IR: Insulin resistance CNS: Central nervous system FFAs: Free fatty acids IRS: Insulin receptor substrates PI3K: AKT-phosphatidylinositol3-kinase PKB: Protein kinase B GLUT4: Glucose transporter 4 MAPK: Ras-mitogen-activated protein kinase BMI: Body mass index VAT: Visceral adipose tissue SAT: Subcutaneous adipose tissue SVF: Stromal vascular fraction ASCs: Adipose stem cells ECM: Extracellular matrix HOMA-IR: Homeostatic Model Assessment for Insulin Resistance IS: Insulin sensitivity LEP-R: leptin receptor GHS-R: growth hormone secretagogue-receptor GLP-1: Glucagon-like peptide-1 GIP: Glucose-dependent insulinotropic polypeptide TSH: Thyrotropin THs: Thyroid hormones FT3: Free triiodothyronine FT4: And free thyroxine HPT: Hypothalamus-pituitary-thyroid axis TRH: Thyrotropin-releasing hormone SHBG: Sex hormone-binding globulin CS: Cushings syndrome 11 HSD: 11-hydroxysteroid-dehydrogenase References Jani M, Jane A, El-Tanani M, Rizzo M

If youre using your thighs or arms, alternate between the left and right sides every other week

Ive seen a number of patients who use this chart and then are surprised when they find that their TSH increases after the switch

Discussion This study demonstrated a significant association between GLP-1RA use and the development of hypersomnolence over both short- and long-term follow-up periods

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