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Clinicians need to provide evidence-based reassurance for preventing unnecessary screening and over-diagnosis related to unproven thyroid cancer risks from treatment with glucagon-like peptide-1 receptor agonists.
A narrative review published in the “Thyroid” Journal suggested that concerns about thyroid cancer linked to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may be exaggerated. While randomized trials demonstrate the rare incidence of thyroid cancer in individuals using GLP-1 RAs, observational studies yield varying and sometimes biased results. Despite early rodent studies hinting at a potential connection between GLP-1 RA use and medullary thyroid cancer (MTC), the connection to non-MTC in humans remains unclear.
Pharmacological studies prompted a black box warning for GLP-1 RAs in patients at risk for MTC, but clinical trials indicate no conclusive evidence of an intensified risk of thyroid cancer. Additionally, observational studies, despite having a higher risk of bias, showed similar low rates of thyroid cancer in GLP-1 RA users. These findings are crucial for clinicians addressing patient concerns, as unwarranted fear of thyroid cancer could result in the underuse of GLP-1 RAs, which are highly effective treatments for type 2 diabetes and obesity.
In essence, while there is some biological plausibility for a link between GLP-1 RAs and thyroid cancer in animal models, clinical evidence does not support an increased risk in humans. Excessive worry over unproven risks could lead to unnecessary screening and harm from overdiagnosis, highlighting the importance of balanced, evidence-based communication with patients.
Thyroid
Glucagon-Like Peptide-1 Receptor Agonists and Thyroid Cancer: A Narrative Review
Ana E Espinosa De Ycaza et al.
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