From the Guidelines
Patients with Graves' disease should not take weight loss medications that can exacerbate their condition, such as sympathomimetic agents like phentermine, and instead consider alternatives like orlistat or GLP-1 receptor agonists under close medical supervision. When considering weight loss medications for patients with Graves' disease, it's crucial to prioritize their thyroid health and avoid medications that could worsen their condition. According to the white paper by the American Gastroenterological Association 1, pharmacotherapy for obesity should be considered as an adjunct to lifestyle changes, but certain medications are contraindicated in patients with hyperthyroidism, such as phentermine.
Some key points to consider when evaluating weight loss medications for patients with Graves' disease include:
- The mechanism of action: medications that increase sympathetic activity, like phentermine, can exacerbate symptoms of Graves' disease, such as rapid heart rate and anxiety 1.
- The potential for drug interactions: certain weight loss medications, like orlistat, may have minimal impact on thyroid function, but others, like GLP-1 receptor agonists, require careful monitoring 1.
- The patient's overall health status: patients with uncontrolled Graves' disease should prioritize getting their thyroid function under control before addressing weight concerns 1.
In terms of specific medication options, orlistat (Xenical, Alli) may be a safer choice for patients with well-controlled Graves' disease, as it works by blocking fat absorption and has minimal impact on thyroid function 1. GLP-1 receptor agonists like liraglutide (Saxenda) may also be considered, but require careful monitoring of thyroid function tests to ensure the medication isn't disrupting thyroid hormone balance 1. Ultimately, any weight loss medication should be started only after thyroid levels are stable and with regular monitoring to ensure the medication isn't worsening the patient's condition.
From the FDA Drug Label
Hyperthyroidism ( 4) The FDA drug label does not answer the question of whether patients with Graves' disease can take weight loss medications, but it does state that phentermine is contraindicated in patients with hyperthyroidism. Since Graves' disease is a cause of hyperthyroidism, it is likely that patients with Graves' disease should not take phentermine.
- Key points:
- Phentermine is contraindicated in patients with hyperthyroidism.
- Graves' disease is a cause of hyperthyroidism.
- Patients with Graves' disease may be at risk if they take phentermine. 2
From the Research
Treatment of Graves' Disease
The treatment of Graves' disease typically involves antithyroid drugs, radioactive iodine, or surgery 3, 4.
Use of Weight Loss Medications
There is no direct evidence in the provided studies regarding the use of weight loss medications in patients with Graves' disease.
Management of Weight Loss in Graves' Disease
However, it is known that patients with Graves' disease often experience weight loss due to the hypermetabolic state caused by excess thyroid hormones 5.
Treatment Approaches
The primary treatment approaches for Graves' disease include:
- Antithyroid drugs, such as methimazole and propylthiouracil, which can help reduce thyroid hormone production 6, 4
- Radioactive iodine, which can help destroy part of the thyroid gland and reduce hormone production 3, 4
- Surgery, which can involve removing part or all of the thyroid gland 3, 4
Considerations for Patients with Graves' Disease
Patients with Graves' disease should be managed by a healthcare provider who can monitor their condition and adjust treatment as needed 3, 4.
- Key considerations include:
- Monitoring thyroid hormone levels and adjusting treatment accordingly
- Managing symptoms such as weight loss, anxiety, and heat intolerance
- Addressing potential complications, such as congestive heart failure and atrial fibrillation 5