From the FDA Drug Label
WEGOVY is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2 [see Warnings and Precautions (5. 1)].
Liraglutide causes thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice It is unknown whether SAXENDA causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined (5. 1).
SAXENDA is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Considerations for using GLP-1 agonists in patients with a family history of parathyroid storm:
- Contraindication: GLP-1 agonists, such as liraglutide and semaglutide, are contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) 1, 2.
- No direct association with parathyroid storm: There is no direct information in the drug labels that associates GLP-1 agonists with parathyroid storm.
- Caution and monitoring: However, given the potential risk of thyroid C-cell tumors, patients with a family history of parathyroid storm should be counseled regarding the potential risk of MTC and symptoms of thyroid tumors 1, 2.
- Uncertain relevance to humans: The human relevance of GLP-1 receptor agonist-induced rodent thyroid C-cell tumors has not been determined 1, 2.
From the Research
There is no established contraindication or specific concern for using GLP-1 agonists like liraglutide, semaglutide, or dulaglutide in patients with a family history of parathyroid storm. A family history of parathyroid storm alone should not prevent the use of these medications, but careful monitoring is recommended. When initiating GLP-1 agonists in these patients, clinicians should perform baseline parathyroid function tests and monitor for any parathyroid-related symptoms during treatment. The standard dosing protocols should be followed: starting with lower doses and titrating upward (e.g., semaglutide starting at 0.25mg weekly for 4 weeks, then 0.5mg weekly, with potential increase to 1mg weekly if needed) 3. GLP-1 agonists primarily affect glucose metabolism by enhancing insulin secretion, reducing glucagon release, and slowing gastric emptying. While there have been concerns about pancreatitis and pancreatic cancer risk with these medications based on animal studies, recent studies have shown no association between GLP-1 receptor agonists and the risk of pancreatitis or pancreatic cancer 4. However, since parathyroid storm is a life-threatening condition, patients with personal history of parathyroid disorders or family history of parathyroid storm should be monitored more closely, with particular attention to symptoms like hypercalcemia, kidney stones, or bone pain that could indicate parathyroid dysfunction. Recent studies have also shown that GLP-1 receptor agonists can be safely used in combination with other medications, such as SGLT2 inhibitors, without increasing the risk of adverse events 5. In fact, a recent study found that the use of GLP-1 receptor agonists was associated with a lower lifetime risk of pancreatitis 6. Therefore, GLP-1 agonists can be used in patients with a family history of parathyroid storm, with careful monitoring and standard dosing protocols.