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Obtain comprehensive baseline labs: TSH, free T4, free T3 Thyroid antibodies (TPO and thyroglobulin if not previously checked) Complete metabolic panel HbA1c and fasting glucose Lipid panel Vitamin D and B12 (commonly deficient in hypothyroidism) During Treatment When to Contact Your Provider Reach out if you experience: Unusual or worsening fatigue not explained by semaglutide initiation New or returning brain fog or cognitive difficulty Constipation that does not improve with typical measures Heart rate changes (especially sustained bradycardia) Cold intolerance or dry skin changes Weight loss plateau despite medication adherence Hair loss beyond what is expected with weight loss Mood changes including depression or anxiety Semaglutide Alternatives for Hypothyroid Patients For patients who cannot take semaglutide or prefer alternatives, several options exist: Tirzepatide (Mounjaro/Zepbound): Dual GLP-1/GIP agonist with potentially greater weight loss