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It is often associated with an open higher-order chromatin structure, increasing nucleosome spacing and allowing easier access for transcription factors and transcription machinery, thereby promoting transcriptional activation 76,89,90

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Importantly, initiation of GLP-1RA may decrease levothyroxine dose requirements in patients with hypothyroidism through weight loss, enhance levothyroxine absorption due to delayed gastrointestinal (GI) transit, and have direct effects on the hypothalamic-pituitary-thyroid axis [23,24,25,26,27,28,29], potentially increasing the risk of thyroid hormone over-replacement (i.e., iatrogenic hyperthyroidism)