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Both direct markers, including pyruvate, lactate, lactate-to-pyruvate ratio, alanine, alanine-to-lysine ratio, acyl-carnitines, and ubiquinone, and indirect markers, such as ammonia, carnitine, creatine kinase, alanine aminotransferase, and aspartate aminotransferase, have been used to identify these dysfunctions [91]

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Who Should Use Extra Caution and When Provider Oversight Is Non-Negotiable Patients with Hashimoto's thyroiditis, Graves' disease, prior thyroid surgery, or TSH-suppressive therapy (e.g., thyroid cancer survivors) require closer monitoring during GLP-1 initiation

Lu T, et al