Is it safe for a patient with a history of thyroid cancer to take Tirzepatide (tirzepatide)?

From the Guidelines

Tirzepatide should not be used in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, but for other types of thyroid cancer, it can be considered on a case-by-case basis with careful monitoring and consultation with the patient's endocrinologist and oncologist.

Key Considerations

• The medication is a GLP-1/GIP receptor agonist primarily used for type 2 diabetes and weight management 1.
• The standard starting dose is 2.5mg subcutaneously once weekly for 4 weeks, then gradually increasing to 5mg, 7.5mg, 10mg, 12.5mg, and potentially 15mg weekly as tolerated 1.
• Common side effects include nausea, vomiting, diarrhea, and abdominal discomfort, which typically improve over time 1.
• The patient should continue regular thyroid cancer surveillance and monitoring as directed by their oncologist while on tirzepatide 1.
• It is crucial to weigh the benefits of using tirzepatide against the potential risks, especially considering the patient's history of thyroid cancer 1.

Monitoring and Precautions

• Patients should be closely monitored for signs of thyroid problems, such as neck swelling, voice changes, or difficulty swallowing, and report these symptoms promptly to their healthcare provider 1.
• Regular monitoring of blood glucose levels, weight, and other health parameters is essential while on tirzepatide 1.
• The decision to use tirzepatide in patients with a history of thyroid cancer should be made with caution and in consultation with relevant specialists, considering the most recent and highest quality evidence available 1.

From the FDA Drug Label

MOUNJARO 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 (MEN 2)

• The patient has a history of thyroid cancer, but the type is not specified.
• The contraindication is specific to medullary thyroid carcinoma (MTC).
• Since the type of thyroid cancer is not specified, and the contraindication is specific to MTC, no conclusion can be drawn regarding the safety of tirzepatide in this patient 2.

From the Research

Thyroid Cancer and Tirzepatide

• There is no direct evidence in the provided studies regarding the use of tirzepatide in patients with a history of thyroid cancer 3, 4, 5, 6, 7.
• The studies primarily focus on the diagnosis, treatment, and management of medullary thyroid carcinoma (MTC) and multiple endocrine neoplasia type 2 (MEN2) 4, 5, 6, 7.
• Tirzepatide is not mentioned in any of the studies, and its safety and efficacy in patients with a history of thyroid cancer are not discussed 3, 4, 5, 6, 7.

Medullary Thyroid Carcinoma (MTC) Treatment

• The treatment of MTC often involves surgery, and in some cases, targeted therapies such as multikinase inhibitors (MKI) or selective RET-inhibitors may be used 4, 5, 6, 7.
• The use of these therapies is typically reserved for patients with progressive or symptomatic disease, and their effectiveness can vary depending on the specific mutation and disease stage 4, 5, 6, 7.

Patient Management

• Patients with a history of thyroid cancer, including MTC, require careful management and follow-up to monitor for disease recurrence or progression 3, 4, 5, 6, 7.
• A multidisciplinary approach, involving specialists from various fields, is often necessary to provide optimal patient care 4, 5, 6, 7.