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It kept me awake at night
Meal replacements may be used in conjunction with food as a partial diet replacement or used to provide the sole source of dietary energy (total replacement) and can minimize or remove the need for patients to choose between other high-energy-dense foods that are of poor nutrition quality [111]

Further research is warranted using datasets that include weight, TSH, and HbA1c measurements (such as EHR data) to formally disentangle the mechanisms linking GLP-1RA initiation, weight loss, optimal levothyroxine dosing, and cardiovascular outcomes

Think of it as a tug-of-war between your stress system (sympathetic) and your rest-and-recovery system (parasympathetic) (6,7)

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