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Tirzepatide carries a boxed warning for risk of thyroid C-cell tumors and is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN2)

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In particular, there exists a palmitoylation cycle of TLR9 mediated by Golgi-resident ZDHHC3 and lysosome-resident PPT1, which regulates the binding of TLR9 to CpG ligands and cytokine production in plasmacytoid dendritic cells (pDC) and macrophages (60)

Symptoms include severe abdominal pain radiating to the back, nausea, and vomiting

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