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Stop immediately and contact your doctor if: Severe neck swelling or a palpable thyroid mass develops Symptoms of thyrotoxicosis appear: rapid heartbeat, severe anxiety, excessive sweating, tremor, sudden unexplained weight loss Severe pancreatitis symptoms: intense upper abdominal pain radiating to the back with nausea and vomiting You discover you are pregnant Discuss with your endocrinologist if: TSH levels become unstable despite levothyroxine adjustments New thyroid nodules appear on follow-up ultrasound Hair loss is severe and persistent despite adequate nutrient levels Fatigue worsens despite thyroid levels appearing normal Autoimmune flare frequency appears to increase You reach your target weight and want to explore discontinuation For patients who achieve their weight loss goals and want to stop GLP-1 therapy, tapering is recommended over abrupt discontinuation