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Exendin-4 from Gila monster venom shares structural similarities with human GLP-1 but has a significantly longer duration of action due to resistance to DPP-4 enzyme breakdown

Nature 2020;577:4326.PubMed 47

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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 [2329], potentially increasing the risk of thyroid hormone over-replacement (i.e., iatrogenic hyperthyroidism)