From the Guidelines
Yes, you can prescribe a GLP-1 receptor agonist to someone with a history of thyroid cancer that was not medullary thyroid cancer. GLP-1 receptor agonists like semaglutide, liraglutide, dulaglutide, and tirzepatide are contraindicated only in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN2) 1. This contraindication exists because GLP-1 receptor agonists have been associated with thyroid C-cell tumors in rodent studies, and C-cells are the origin of medullary thyroid cancer. However, for patients with a history of other types of thyroid cancer such as papillary, follicular, or anaplastic thyroid cancer, GLP-1 receptor agonists are not contraindicated as these cancers arise from different cell types. When prescribing, it's still important to monitor thyroid function periodically, especially if the patient is on thyroid replacement therapy, as weight loss may affect thyroid hormone requirements. Some key points to consider when prescribing GLP-1 receptor agonists include:
- Monitoring for gastrointestinal side effects, which are common with these medications
- Adjusting doses of other medications, such as insulin or insulin secretagogues, to minimize the risk of hypoglycemia
- Considering the potential benefits of GLP-1 receptor agonists on cardiovascular and kidney outcomes, as demonstrated in several studies 1. Overall, the benefits of GLP-1 receptor agonists in patients with a history of non-medullary thyroid cancer likely outweigh the risks, making them a viable treatment option for these patients 1.
From the Research
GLP-1 Receptor Agonists and Thyroid Cancer Risk
- The use of GLP-1 receptor agonists (GLP-1 RAs) in patients with a history of non-medullary thyroid cancer is a topic of ongoing debate 2, 3, 4, 5.
- Studies have investigated the association between GLP-1 RA use and thyroid cancer risk, with some finding an increased risk of thyroid cancer, particularly medullary thyroid cancer 3, 5.
- However, other studies have found no conclusive evidence of an elevated thyroid cancer risk associated with GLP-1 RA use 2, 4.
- A systematic review and meta-analysis of randomized controlled trials found a significant increase in the risk of overall thyroid cancer with GLP-1 RA treatment, but the association remained significant only for trials lasting at least 104 weeks 5.
- Another study found no evidence that GLP-1 RA use is associated with an increased risk of thyroid cancer with follow-up ranging from 1.8 to 3.0 years, providing some reassurance to patients and clinicians about the short-term safety of these drugs 4.
Considerations for Prescribing GLP-1 RAs
- When considering prescribing a GLP-1 RA to someone with a history of non-medullary thyroid cancer, it is essential to weigh the potential benefits and risks of treatment 2, 4.
- The presence of a familial history of non-medullary thyroid cancer may be an independent prognostic factor for tumor recurrence in younger patients with conventional papillary thyroid carcinoma 6.
- Clinicians should carefully evaluate the individual patient's risk factors and medical history before making a decision about GLP-1 RA treatment 2, 3, 4, 5.