GLP-1 Receptor Agonists in Patients with Papillary Thyroid Cancer
GLP-1 receptor agonists can be safely used in patients with papillary thyroid cancer, as current evidence does not demonstrate a conclusive increased risk of thyroid cancer recurrence or progression with these medications. 1
Current Evidence on GLP-1 RAs and Thyroid Cancer
FDA Labeling and Guidelines
- GLP-1 receptor agonists carry a black box warning related to thyroid C-cell tumors (medullary thyroid carcinoma), not papillary thyroid cancer 2
- The FDA label for liraglutide notes that in clinical trials, there were 7 reported cases of papillary thyroid carcinoma in patients treated with liraglutide versus 1 case in comparator-treated patients (1.5 vs. 0.5 cases per 1,000 patient-years) 3
- Most of these papillary thyroid carcinomas were <1 cm in greatest diameter and were diagnosed after thyroid ultrasound screening 3
Recent Research Evidence
- A 2025 international multisite cohort study with data from six population-based databases found no evidence that GLP-1 RA use is associated with an increased risk of thyroid cancer compared to DPP-4 inhibitors (pooled weighted HR 0.81, CI 0.59-1.12) 1
- A 2024 narrative review concluded that evidence from randomized controlled trials indicates thyroid cancer occurrence is infrequent in individuals exposed to GLP-1 RAs, and there is no conclusive evidence of elevated thyroid cancer risk 4
- A 2017 study specifically examining papillary thyroid cancer cells found that GLP-1 receptor agonists did not influence cell proliferation, signaling pathways, or energy metabolism in PTC cells 5
Clinical Considerations for Using GLP-1 RAs in Patients with Papillary Thyroid Cancer
Patient Selection
- GLP-1 RAs are contraindicated in patients with:
Monitoring Recommendations
- Regular thyroid monitoring may be prudent, though not specifically mandated for papillary thyroid cancer patients
- Baseline calcitonin measurements may be considered, as calcitonin is a biological marker of medullary thyroid cancer 3
- Follow standard post-treatment surveillance protocols for papillary thyroid cancer regardless of GLP-1 RA use
Benefits vs. Risks
- GLP-1 RAs provide significant benefits for patients with type 2 diabetes:
- The theoretical risk of papillary thyroid cancer progression must be balanced against these established benefits
Practical Approach to Management
Assess baseline risk:
- Review thyroid cancer history, treatment status, and remission status
- Evaluate presence of other contraindications to GLP-1 RAs
Discuss with patient:
- Explain that current evidence does not show increased risk of papillary thyroid cancer progression with GLP-1 RAs
- Review the established benefits of GLP-1 RAs for their condition
- Discuss the black box warning related to medullary thyroid cancer (not papillary)
Monitor appropriately:
- Continue standard thyroid cancer surveillance
- Monitor for common GLP-1 RA side effects (gastrointestinal symptoms, etc.)
Potential Pitfalls and Caveats
- Pharmacovigilance studies have shown disproportionality for thyroid cancer reports with GLP-1 RAs 7, but these studies cannot establish causality
- Long-term follow-up data (>3 years) on GLP-1 RA use in papillary thyroid cancer patients is limited 1
- Patients may have heightened anxiety about using medications with any theoretical thyroid cancer risk, requiring thorough counseling
In conclusion, while monitoring is appropriate, the current evidence supports the safety of GLP-1 receptor agonists in patients with papillary thyroid cancer, and these medications should not be withheld when clinically indicated for diabetes management or weight loss.