Ozempic Does Not Treat Multinodular Thyroid and Is Contraindicated in Certain Thyroid Cancers
Ozempic (semaglutide) does not treat multinodular goiter and is absolutely contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN 2). 1
Critical Contraindications
- Semaglutide carries a boxed warning for medullary thyroid cancer risk based on animal studies showing thyroid C-cell tumors in rodents, making it absolutely contraindicated in patients with personal or family history of MTC or MEN 2 syndrome 2, 1
- This contraindication applies to all formulations of semaglutide (Ozempic for diabetes, Wegovy for obesity, and oral Rybelsus) 2, 3
Thyroid Conditions That Are NOT Contraindications
- Primary hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, and treated Graves' disease are NOT contraindications for semaglutide use 1
- The contraindication is specific only to MTC and MEN 2, not to benign thyroid conditions like multinodular goiter 1
- GLP-1 receptors are expressed in the thyroid gland, which explains some pleiotropic effects, but this does not translate to therapeutic benefit for thyroid nodules 2
Long-Term Safety Data on Thyroid Cancer
- The SUSTAIN-6 and PIONEER-6 cardiovascular outcome trials showed no increased rates of thyroid cancer with semaglutide, though follow-up time may have been insufficient to definitively assess this outcome 1, 4
- No unexpected thyroid safety issues have emerged in clinical trials, and the established safety profile is similar to other GLP-1 receptor agonists 4
- Definitive conclusions for thyroid cancer risk cannot be drawn due to the low incidence of these conditions in clinical trials 4
Clinical Implications for Patients with Type 2 Diabetes and Multinodular Goiter
- For patients with type 2 diabetes and multinodular goiter (without MTC or MEN 2), semaglutide can be safely used for glycemic control and cardiovascular risk reduction 1
- The cardiovascular benefits of semaglutide (26% reduction in composite cardiovascular death, nonfatal MI, or nonfatal stroke) outweigh theoretical thyroid cancer risks in appropriate patients 1
- Patients should be screened for personal or family history of MTC or MEN 2 before initiating semaglutide 1, 3
Monitoring Recommendations
- Thyroid function monitoring is recommended for patients with hypothyroidism on semaglutide, though this is for managing the underlying thyroid condition, not because semaglutide treats it 2
- GLP-1 receptor expression in the thyroid does not provide therapeutic benefit for multinodular goiter or other benign thyroid conditions 2
Common Pitfall to Avoid
- Do not confuse the contraindication for medullary thyroid cancer with a contraindication for all thyroid conditions—benign thyroid diseases like multinodular goiter, hypothyroidism, and hyperthyroidism are not contraindications 1
- Semaglutide has no therapeutic role in treating thyroid nodules or goiter; it is indicated solely for type 2 diabetes and obesity management 2, 3