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Lu J et al

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Users are warned about thyroid cancer, pancreatitis, kidney problems, gallbladder disease, and allergic reactions

due to NDMA (cancer causing carcinogen) impurities

Some warning signs of Tier 3 operators include prices significantly below market rates, generic COAs that do not match specific batch numbers, reluctance to provide video calls showing their facility, and email addresses using free services like Gmail or Outlook rather than corporate domains

Slow titration (increasing the dose gradually) reduces severity substantially (GI Tolerability Across SURMOUNT 1-4, DOM 2025)