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Consider referral to an endocrinologist for: Pregnancy planning or current pregnancy Persistently abnormal TSH despite adherence to treatment Presence of thyroid nodules, goiter, or compressive symptoms Rapid changes in thyroid size or function Diagnostic uncertainty or complex thyroid disease Patients with diabetes and pre-existing retinopathy who are starting semaglutide should also coordinate with an ophthalmologist for appropriate monitoring

At this point, genuinely, it is an unknown with these high-efficacy drugs like semaglutide and tirzepatide, Angadi said

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