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Contact your healthcare provider if you experience: Signs of hypothyroidism : increased fatigue, cold intolerance, constipation, weight gain despite semaglutide, depression, or cognitive changes Signs of hyperthyroidism : anxiety, tremor, palpitations, heat intolerance, unexplained weight loss beyond expected, or insomnia Severe gastrointestinal symptoms : persistent nausea, vomiting, or diarrhea that might affect medication absorption Hypoglycemia symptoms : shakiness, sweating, confusion, or dizziness (particularly if also taking insulin or sulfonylureas) Maintain a consistent schedule for taking levothyroxine—ideally at the same time each day