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Standard semaglutide titration: Weeks 1-4: 0.25 mg weekly Weeks 5-8: 0.5 mg weekly Weeks 9-12: 1.0 mg weekly Week 13+: 1.7 mg or 2.4 mg weekly (target dose) Hashimoto's-adjusted approach: Weeks 1-6: 0.25 mg weekly (extended to allow thyroid monitoring at week 6) Weeks 7-12: 0.5 mg weekly (TSH check before increasing) Weeks 13-16: 1.0 mg weekly Week 17+: Assess whether higher doses are needed The extended timeline allows for thyroid function checks at each step, ensuring levothyroxine doses are adjusted proactively rather than reactively

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In addition, multiple state boards of pharmacy had taken disciplinary action against the pharmacys license, and another had denied its application for license renewal.