Sautee the onion and garlic until soft, but make sure not to burn garlic.
Set aside onion and garlic to cool.
Combine turkey, egg, breadcrumbs, ketchup, worcestershire sauce, salt and pepper, garlic and onion, until all the ingredients are thoroughly mixed (I added about 1/2 Tbsp of Frank's Red Hot for a little kick, but can be decreased/increased depending on preference).
Transfer mixture to a greased 8x4 inch loaf pan.
Brush ketchup on top to coat.
Bake at 350 degrees for about 50-55 minutes.
If using the parmesan, add at last 5 minutes and set oven to broil so cheese gets slightly crisp (keep an eye on it so it doesn't burn!).
Let meatloaf set for 5 minutes after removing from oven.