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Since levothyroxine requires an acidic gastric environment for optimal dissolution and absorption, and its absorption can be affected by the rate of gastric emptying, patients may experience variations in thyroid hormone levels when starting semaglutide therapy

Though rare, they can be serious if ignored

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doi: 10.1093/ajcn/66.4.741

10.1038/s41598-018-26956-7 87 LiuM.LiL.ChuJ.ZhuB.ZhangQ.YinX.et al (2015)