From the Guidelines
GLP-1 receptor agonists can be safely prescribed for patients with a maternal history of follicular thyroid carcinoma. There is no contraindication to using medications like semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), liraglutide (Victoza, Saxenda), or tirzepatide (Mounjaro, Zepbound) in patients with a family history of thyroid cancer. While there was initially concern about GLP-1 medications based on rodent studies showing an increased risk of medullary thyroid carcinoma (MTC), this risk appears specific to rodents and has not been demonstrated in humans 1. Additionally, follicular thyroid carcinoma has a different cellular origin than medullary thyroid carcinoma. The black box warning for GLP-1 medications applies specifically to patients with a personal or family history of MTC or Multiple Endocrine Neoplasia syndrome type 2 (MEN2), not follicular thyroid cancer, as stated in the 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease 1. The patient should still undergo routine thyroid monitoring as recommended for the general population, but no special monitoring is required solely due to GLP-1 medication use in the context of a family history of follicular thyroid cancer. Some key considerations for GLP-1 receptor agonist use include:
- Contraindications such as a history of serious hyper-sensitivity reaction to the drug, personal or family history of medullary thyroid cancer, or Multiple Endocrine Neoplasia syndrome type 2 (MEN2) 1
- Cautions such as use in patients with severe renal impairment or end-stage renal disease, history of pancreatitis, or history of gastroparesis 1
- Potential side effects such as nausea, vomiting, and diarrhea, which are common but usually tolerable with dose titration and abate over several weeks to months 1
- Benefits such as reduced risk of major adverse cardiovascular events and slowed eGFR decline in patients with type 2 diabetes and chronic kidney disease 1
From the Research
GLP-1 and Thyroid Cancer Risk
- The relationship between GLP-1 receptor agonists and thyroid cancer risk has been investigated in several studies 2, 3, 4, 5, 6.
- A 2025 study found no evidence that GLP-1 receptor agonist use is associated with an increased risk of thyroid cancer, with a pooled weighted hazard ratio of 0.81 (CI 0.59-1.12) 2.
- A 2024 narrative review concluded that there is no conclusive evidence of elevated thyroid cancer risk with GLP-1 receptor agonist use, despite biological plausibility and some signals from pharmacovigilance studies 3.
- However, a 2023 study found an increased risk of all thyroid cancer and medullary thyroid cancer with use of GLP-1 receptor agonists, particularly after 1-3 years of treatment (adjusted HR 1.58,95% CI 1.27-1.95) 4.
- A 2024 meta-analysis of randomized controlled trials found a significant increase in the risk of overall thyroid cancer with GLP-1 receptor agonist treatment (MH-OR 1.52,95% CI 1.01-2.29) 5.
Maternal History of Follicular Thyroid Carcinoma
- There is limited direct evidence on the specific risk of thyroid cancer with GLP-1 receptor agonist use in individuals with a maternal history of follicular thyroid carcinoma.
- However, the available studies suggest that the overall risk of thyroid cancer with GLP-1 receptor agonist use is still being debated and may depend on various factors, including duration of treatment and individual patient characteristics 2, 3, 4, 5, 6.
Key Findings
- The evidence on the association between GLP-1 receptor agonists and thyroid cancer risk is inconsistent and requires further investigation 2, 3, 4, 5, 6.
- Patients with a maternal history of follicular thyroid carcinoma should discuss their individual risk factors and concerns with their healthcare provider when considering GLP-1 receptor agonist treatment.