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Comprehensive Medical Screening: Clinicians should evaluate for: Thyroid nodules or goiter : Baseline neck examination and review of recent thyroid ultrasound if clinically indicated Personal or family history of thyroid cancer : Particularly medullary thyroid carcinoma Comorbid conditions : Type 2 diabetes, cardiovascular disease, pancreatitis history Gastrointestinal disorders : Severe gastroparesis (potential contraindication) Renal function : Use caution in patients at risk for volume depletion/renal impairment Psychiatric conditions : Depression, eating disorders Pregnancy status : These medications are not recommended during pregnancy and should be discontinued when pregnancy is recognized Laboratory Assessment: Baseline testing should include: TSH and free T4 Comprehensive metabolic panel (renal and hepatic function) Lipid panel Hemoglobin A1c (if diabetic or prediabetic) Routine calcitonin screening or thyroid ultrasound is not recommended solely for GLP-1 therapy initiation

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Overall, eating a balanced diet and supplementing when necessary will keep your B12 levels in check.