A large target trial emulation compared continuing versus stopping GLP-1 receptor agonists before thyroidectomy in adults with type 2 diabetes. Continuing GLP-1s was not associated with excess perioperative harm, though signals for lower diabetic ketoacidosis and mortality remained hypothesis-generating rather than definitive. The study addresses a practical perioperative decision that affects anesthesia teams and pre-op protocols. For biotech and payer stakeholders, it offers evidence that could reduce unnecessary medication holds—while reinforcing the need for confirmatory prospective studies around rare adverse outcomes.