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TABLE 2 The clinical characteristics of the 20 included cases

[3] [4] Patients should promptly report symptoms such as neck mass, difficulty swallowing, or persistent hoarseness

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The most common side effects of GLP-1 tablets are usually: These are usually most noticeable when starting treatment or increasing the dose

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Recommended timing strategies: Option 1 (Morning dosing for both): Take Rybelsus immediately upon waking with up to 120ml water Wait 30 minutes Take levothyroxine with a full glass of water Wait another 30 minutes before eating breakfast or drinking coffee Total fasting time: approximately 60 minutes from waking Option 2 (Split dosing): Take Rybelsus first thing in the morning as directed Wait 30 minutes, then eat breakfast Take levothyroxine at bedtime (34 hours after last meal) The split-dosing approach may offer better adherence for some patients and ensures maximum separation between the two medications