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The protocol: Take levothyroxine on an empty stomach, 60 minutes before breakfast Wait the full 60 minutes (not 30) during semaglutide titration Recheck TSH 6 to 8 weeks after starting semaglutide or after dose changes Adjust levothyroxine dose if TSH drifts out of range A 2023 study in Thyroid (Cappelli et al.) found that 18% of patients on stable levothyroxine required dose increases (average 12.5 mcg) after starting GLP-1 therapy, likely due to absorption changes during the adaptation period
Because of the unknown potential for serious adverse reactions in the breastfed infant due to the possible accumulation of SNAC, an absorption enhancer for Ozempic and Rybelsus tablets, and because there are alternative formulations of semaglutide that do not contain SNAC that can be used during lactation, advise patients that breastfeeding is not recommended during treatment with Ozempic or Rybelsus tablets Please click here for Ozempic and Rybelsus tablets Prescribing Information, including Boxed Warning
This guide walks through how escalation typically works, signs that you may be ready for a higher dose, and how to approach increases safely with clinical support
PMID 10220143
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