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Ethics declarations Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest

Semin Immunol 21:2227 Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Gordon D, Copeland T, Dagostino D, Friedenberg G, Ridge C, Bubes V, Giovannucci EL, Willett WC, Buring JE (2019) Vitamin D supplements and prevention of cancer and cardiovascular disease

Contact your healthcare provider if you experience: Hot flashes accompanied by chest pain, palpitations, or irregular heartbeat Severe or persistent flushing with associated shortness of breath or dizziness Hot flashes that significantly interfere with daily activities or sleep quality New or worsening symptoms despite lifestyle modifications Severe, persistent abdominal pain (especially radiating to the back) with or without vomiting Yellowing of skin/eyes (jaundice), pale stools, or dark urine Signs of allergic reaction including facial/lip swelling, rash, hives, or difficulty breathing Signs of thyroid dysfunction including tremor, anxiety, or changes in bowel habits Concurrent symptoms such as excessive sweating, fever, or night sweats If you're taking tirzepatide with insulin or sulfonylureas, check your blood glucose during episodes that resemble hot flashes, as hypoglycemia can cause similar symptoms

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Socioeconomic and health system impact PD imposes a significant socioeconomic burden, including direct healthcare costs (e.g., medications, hospitalizations, and surgery) and indirect costs (e.g., lost income, caregiver absenteeism, and reduced productivity)