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Important precautions and safety considerations include: Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (precaution per UK SmPC) Severe gastrointestinal disease History of pancreatitis (requires careful assessment) Diabetic retinopathy requiring close monitoring Risk of gallbladder disease (seek care for persistent upper abdominal pain, fever, jaundice) Dehydration and possible kidney injury with severe gastrointestinal symptoms (maintain hydration) Small mean heart rate increase noted in trials (consider monitoring in patients with cardiovascular disease) Reduced exposure to oral contraceptives (use barrier contraception for 4 weeks after initiation and dose increases) Avoid during pregnancy and breastfeeding unless clearly necessary When to seek urgent medical attention: Severe, persistent abdominal pain (potential pancreatitis) Signs of allergic reaction (rash, difficulty breathing, facial swelling) Persistent vomiting leading to dehydration Symptoms of hypoglycaemia if taking insulin or sulfonylureas concurrently Blood pressure 180/120 mmHg or if chest pain, severe breathlessness, neurological symptoms, or acute confusion develop Regular follow-up with healthcare professionals, typically every 36 months, allows for assessment of treatment response, adverse effects, and necessary adjustments to the overall treatment plan

The MR signals of our cases were unlike a typical melanin signal, but signals of bone involvement, tumor necrosis region, inflammatory reaction around the tumor and so on [10, 14]