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6.6 When to Refer Referral to a clinician or dietitian may be appropriate when: Persistent GI intolerance limits intake Weight loss exceeds 20% body weight Multiple laboratory abnormalities are present Underlying malabsorptive or gastrointestinal disease exists Patient is elderly or medically complex GLP-1 therapy should not occur in isolation from nutritional oversight when risk factors are present

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Research has shown that Se supplementation can improve thyroid function in areas with iodine deficiency, suggesting that Se not only enhances the conversion of T4 to T3 but also supports overall thyroid health [91]

Am Heart J 2004;148:690-5