From the Guidelines
You can prescribe a GLP-1 receptor agonist to someone with a history of non-medullary thyroid cancer, as long as they do not have a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN2). These medications, such as semaglutide, liraglutide, dulaglutide, and tirzepatide, are generally considered safe for patients with a history of differentiated thyroid cancer (papillary, follicular) that has been treated and is in remission 1. The most recent and highest quality study, published in 2023, confirms that GLP-1 agonists are contraindicated in patients with a personal or family history of MTC or MEN2, due to the association with C-cell hyperplasia and medullary thyroid tumors in rodent studies 1.
Before prescribing, it is essential to:
- Confirm the specific type of thyroid cancer the patient had
- Ensure they are in remission with appropriate follow-up care
- Document that they did not have MTC or MEN2 Regular thyroid monitoring should continue as part of their cancer survivorship care, but no additional monitoring is required specifically due to GLP-1 agonist use for non-medullary thyroid cancer survivors 1.
Key considerations for GLP-1 receptor agonist use include:
- Contraindications: personal or family history of MTC or MEN2, pregnancy, and breastfeeding
- Common side effects: nausea, vomiting, diarrhea, and headache
- Monitoring: regular thyroid monitoring, as well as monitoring for potential side effects such as pancreatitis and acute gallbladder disease 1.
In summary, GLP-1 receptor agonists can be prescribed to patients with a history of non-medullary thyroid cancer, as long as they do not have a personal or family history of MTC or MEN2, and are used with caution and regular monitoring.
From the Research
GLP-1 Receptor Agonists and Thyroid Cancer
- GLP-1 receptor agonists are contraindicated in patients with a history of medullary thyroid cancer 2
- The use of GLP-1 receptor agonists may be associated with an increased risk of thyroid cancer, particularly medullary thyroid cancer 3
- There is no clear consensus on the optimal approach to screening patients for thyroid cancer prior to initiating GLP-1 receptor agonist treatment or evaluating for thyroid cancer during treatment 4
Considerations for Prescribing GLP-1 Receptor Agonists
- GLP-1 receptor agonists should be used with caution in patients with a history of pancreatitis of a known cause 2
- The risk of thyroid cancer associated with GLP-1 receptor agonist use is still being researched and debated 5
- Head-to-head clinical studies have demonstrated that all GLP-1 receptor agonist agents are effective therapeutic options for reducing A1C, but differences exist in terms of magnitude of effect and frequency of adverse effects 6
Prescribing GLP-1 Receptor Agonists to Patients with a History of Thyroid Cancer
- Patients with a history of medullary thyroid cancer should not be prescribed GLP-1 receptor agonists 2
- For patients with a history of non-medullary thyroid cancer, the decision to prescribe GLP-1 receptor agonists should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 3, 4, 5