GLP-1 Receptor Agonists in Patients with History of Thyroid Cancer

Contraindications and Risk Assessment

The FDA states 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 FDA Black Box Warnings 1
The American Heart Association, as published in Circulation, recommends that GLP-1 receptor agonists carry an FDA Black Box Warning regarding the risk of thyroid C-cell tumors, making them contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with multiple endocrine neoplasia syndrome type 2 1
Patients at risk for thyroid C-cell tumors should not use GLP-1 receptor agonists due to safety concerns, as recommended by the American College of Cardiology 2

The American Diabetes Association, as published in Diabetes Care, recommends assessing thyroid cancer history and considering the risk/benefit ratio based on the need for glycemic control, with GLP-1 receptor agonists being absolutely contraindicated in patients with a history of medullary thyroid carcinoma or family history of MTC 1, 2, 3
For non-MTC thyroid cancer history, the American College of Cardiology recommends considering time since complete remission, evaluating risk/benefit ratio, and implementing close monitoring with regular thyroid function tests if considering GLP-1 RA therapy 1, 3

The American Heart Association recommends considering alternative treatment options, such as DPP-4 inhibitors, metformin, and insulin therapy, for patients with thyroid cancer history where GLP-1 RAs are contraindicated 1, 3
The American Diabetes Association recommends metformin as first-line therapy for patients with contraindications to GLP-1 RAs 3

Patients should be informed about the potential risks and the importance of reporting any symptoms related to thyroid abnormalities, as recommended by the American College of Cardiology 2

The American Heart Association recommends SGLT-2 inhibitors as a beneficial alternative for cardiovascular and renal protection in patients who cannot use GLP-1 RAs due to MTC/MEN2 history 4