From the Guidelines
There is no general requirement to discontinue GLP-1 medications in patients with papillary thyroid cancer, as current evidence does not demonstrate that GLP-1 medications worsen outcomes in patients with existing papillary thyroid cancer. The decision to continue or discontinue GLP-1 medications should be individualized based on each patient's specific clinical situation, taking into account their cancer stage, treatment plan, and overall health status 1. Patients with papillary thyroid cancer should discuss their medication regimen with their endocrinologist or oncologist, who can evaluate their particular case and make recommendations based on their specific circumstances.
Key Considerations
- Theoretical concerns about GLP-1 medications and thyroid cancer stem from early animal studies showing increased medullary thyroid cancer in rodents, but this has not been demonstrated for papillary thyroid cancer in humans 1.
- GLP-1 receptor agonists have been shown to be safe and effective for decreasing A1C and promoting weight loss in youth with type 2 diabetes, but should not be used in individuals with a family history of medullary thyroid cancer 1.
- The most recent evidence suggests that GLP-1 medications can be continued in patients with papillary thyroid cancer, but close monitoring and individualized decision-making are necessary 1.
Recommendations
- Patients with papillary thyroid cancer taking GLP-1 medications should continue their medication as prescribed until they can consult with their specialist.
- Endocrinologists and oncologists should evaluate each patient's specific case and make recommendations based on their cancer stage, treatment plan, and overall health status.
- Close monitoring and individualized decision-making are necessary to ensure the best possible outcomes for patients with papillary thyroid cancer taking GLP-1 medications.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Papillary Thyroid Cancer and GLP1 Medications
- The provided studies do not directly address the question of whether patients with papillary thyroid cancer should be taken off GLP1 medications 2, 3, 4, 5.
- However, one study investigated the association between GLP1 receptor agonists and the risk of thyroid cancer, finding no increased risk with GLP1-RA use compared to DPP-4i use 6.
- The study found a pooled weighted hazard ratio of 0.81 (CI 0.59-1.12) for thyroid cancer among GLP1-RA users compared to DPP-4i users, suggesting no significant association between GLP1-RA use and thyroid cancer risk 6.
- It is essential to note that the study had a relatively short follow-up period, ranging from 1.8 to 3.0 years, and therefore, the evidence was insufficient to rule out excess risk with long-term use 6.
Treatment of Papillary Thyroid Cancer
- The treatment of papillary thyroid cancer typically involves surgical excision, radioactive iodine ablation, and thyroid-stimulating hormone (TSH) suppression 2, 3.
- The choice of treatment depends on patient factors, disease factors, and the decisions of the patient and treatment team 2.
- Recent studies have explored emerging therapies, including redifferentiation agents, antiangiogenic agents, and multi-tyrosine kinase inhibitors, for the treatment of papillary thyroid cancer 3, 4.
Management of Papillary Thyroid Cancer
- Current guidelines recommend individualized treatment approaches based on patient risk and response to therapies 4.
- Physician practices and attitudes towards TSH suppression in patients with papillary thyroid cancer have been explored, with varying results 5.
- The use of GLP1 receptor agonists in patients with type 2 diabetes has been investigated, with no significant association found between GLP1-RA use and thyroid cancer risk 6.