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Low levels of vitamin B-12 impair the synthesis of thyroid hormone, leading to a worsening of hypothyroidism symptoms

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Titrate semaglutide and tirzepatide more slowly (hold each dose level for four weeks instead of the standard two to four weeks) if GI side effects are severe

This distinguishes it from GLP-1 medications, which in some patients have been associated with significant lean mass reduction alongside fat loss

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AMPK activation upregulates the same fat oxidation pathways that sirtuins activate, so the combination produces additive effects without redundancy