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Expected Timeline Weeks 14: Appetite change Weeks 48: Visible weight change Weeks 812: Metabolism becomes more efficient 12+ weeks: Steady monthly results Who Should Avoid GLP-1 (Rare Cases) History of Medullary Thyroid Cancer Family history of MEN2 Uncontrolled hypothyroidism (TSH extremely high) Severe GI disorders (gastroparesis, bowel obstruction) I will not start GLP-1 if your bloodwork is unstable or you show severe symptoms like: Persistent fast heart rate Severe constipation Unmanaged fatigue Gastrointestinal blockage history What to Expect If You Start GLP-1 With Hypothyroidism Heres the exact guidance I give patients: Dose Titration Start low

Vomiting: Less common than nausea (about 9% of patients) but can occur, especially if you eat too much too quickly

What this changes for clinical practice Nothing yet, formally

But here's the thing I need you to hear: the brain doesn't have separate volume knobs for food cravings and life cravings

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