A large target trial emulation evaluated whether patients with type 2 diabetes should stop or continue GLP-1 receptor agonists before thyroidectomy. Continuing therapy was not associated with excess perioperative harm, although the analysis flagged hypothesis-generating signals for lower risks of diabetic ketoacidosis and mortality. The findings arrive as perioperative guidance remains in flux across institutions, with anesthesiology teams weighing aspiration risk concerns against diabetes control and complication avoidance. The key practical takeaway is that a full stop may not be universally required, but clinicians will still need to individualize based on patient risk profiles and local protocols.