From the Guidelines
GLP-1 receptor agonists can be used in patients who have undergone thyroidectomy, but it is crucial to consider the potential risks and contraindications, particularly the increased risk of thyroid C-cell tumors, as noted in the 2023 study 1. When prescribing GLP-1 receptor agonists to patients with a history of thyroidectomy, it is essential to:
- Monitor thyroid function tests regularly to ensure euthyroid status
- Be aware of the potential gastrointestinal side effects, such as nausea, vomiting, and diarrhea, which may affect the absorption of thyroid medication
- Consider separating the administration times of GLP-1 agonists and thyroid medication to minimize potential interactions
- Choose a GLP-1 receptor agonist that is suitable for the patient's specific needs, such as semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), or liraglutide (Victoza, Saxenda)
- Follow the recommended dosing and titration schedules, such as starting semaglutide at 0.25mg weekly for 4 weeks, then 0.5mg weekly, potentially increasing to 1mg weekly as tolerated, as outlined in the 2020 expert consensus decision pathway 1. It is also important to note that GLP-1 receptor agonists are contraindicated in patients with a personal or family history of medullary thyroid carcinoma and in patients with multiple endocrine neoplasia syndrome type 2, as stated in the 2019 scientific statement from the American Heart Association and the Heart Failure Society of America 1.
From the Research
GLP-1 Therapy in Patients with Thyroidectomy
- GLP-1 receptor agonist (GLP-1 RA) therapy has been associated with an increased risk of thyroid C-cell hyperplasia and C-cell tumors in rodents 2, 3, 4.
- A case report described a patient who underwent a total thyroidectomy and was managed with levothyroxine, experiencing suppressed thyroid stimulating hormone (TSH) levels after initiation of subcutaneous semaglutide, a GLP-1 RA 2.
- The reduction in TSH levels necessitated a 25% dose reduction of levothyroxine, highlighting the need for closer monitoring of patients on GLP-1 RA therapy 2.
- A meta-analysis of randomized controlled trials found that GLP-1 RA treatment was associated with a significant increase in the risk of overall thyroid cancer, with a small increase in absolute risk 3.
- The association between GLP-1 RA therapy and thyroid cancer risk in humans is still uncertain and requires further study 3, 4.
Post-Thyroidectomy Care and Complications
- Thyroid surgery can cause potentially fatal complications during the early post-operative phase, and nurses should be aware of the early signs and symptoms of potential complications 5.
- Early detection and rapid response are key to maintaining patient safety and minimizing harm in patients who have undergone thyroidectomy 5.
Considerations for GLP-1 Therapy in Post-Thyroidectomy Patients
- Patients with a history of thyroidectomy who are initiated on GLP-1 RA therapy may require closer monitoring of their TSH levels and levothyroxine doses 2.
- The potential risk of thyroid cancer associated with GLP-1 RA therapy should be considered in patients with a history of thyroidectomy, although the absolute risk is still uncertain 3, 4.