American Association of Clinical Endocrinologists and American College of Endocrinology: clinical practice guidelines for developing a diabetes mellitus comprehensive care plan 2015
Very mild or subclinical hypothyroidism with no significant symptoms In cases of subclinical hypothyroidism, where the TSH is slightly elevated but free T4 remains normal, and the patient has minimal or no symptoms, GLP-1 therapy may be started if there is a strong clinical indication such as prediabetes, elevated waist circumference, or high cardiovascular risk
They apply whether you are using a pre-filled pen or drawing from a reconstituted vial with a syringe
Typically, those who should avoid GLP-1s are those with: A personal or family history of certain thyroid cancers Multiple endocrine neoplasia syndrome type 2 A history of pancreatitis Severe gastroparesis (delayed stomach emptying) Pregnancy or plans to become pregnant Additionally, if you have a history of eating disorders, severe depression or unrealistic weight loss expectations, its important to address these concerns with your physician before considering medication
The new 5-HT hypothesis of depression: cell-mediated immune activation induces indoleamine 2,3-dioxygenase, which leads to lower plasma tryptophan and an increased synthesis of detrimental tryptophan catabolites (TRYCATs), both of which contribute to the onset of depression
Lancet Psychiatry 3 , 10491058 (2016)