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Barreto-Vianna AR, Aguila MB, Mandarim-de-Lacerda CA

Mechanistically, delayed gastric emptying is due to cholinergic inhibition of parasympathetic outflow and nitric oxide (NO) release in a cAMP/PKA-dependent manner [37]

The most comprehensive evidence comes from three sources: the Phase 2 trial published in the New England Journal of Medicine , the Phase 3 TRIUMPH-4 trial, and a systematic review and meta-analysis that synthesized data from 878 total participants across three randomized controlled trials

[11] The FDA warning pertains specifically to medullary thyroid carcinoma, not to common thyroid conditions like hypothyroidism or the use of levothyroxine