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The troglitazone induces cytochrome P450, leading to hepatotoxic reactive metabolites
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Two things can shift your thyroid needs during weight loss: Absorption variability (especially early on with dose increases) BNF Body weight changes (thyroid replacement dose requirements can change as weight changes) A practical approach many clinicians use is: Check TSH ( free T4) about 68 weeks after : starting tirzepatide, or a significant dose escalation, or a big, sustained drop in weight NICE also flags that because tirzepatide delays gastric emptying, some oral medicines (particularly those with a narrow therapeutic index) may need monitoring during escalation
