Kelly Clare A, Sipos Jennifer A
Division of Endocrinology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106 USA.
Division of Endocrinology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
J Clin Endocrinol Metab. 2025 May 19;110(6):e2080-e2087. doi: 10.1210/clinem/dgae722.
Glucagon-like peptide 1 receptor agonists (GLP1RAs) have rapidly changed the landscape of diabetes and obesity treatment. Enthusiasm for their use is tempered with concerns regarding their risk for inducing C-cell tumors based on preclinical studies in rodents. A black-box warning from the US Food and Drug Administration recommends against using GLP1RA in patients with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2A or 2B (MEN2), providing clear guidance regarding this cohort of patients. However, emerging data also suggest an increased incidence of differentiated thyroid cancer (DTC) in patients treated with these agents. Other studies, though, have not confirmed an association between GLP1RAs and DTC. With conflicting results concerning thyroid cancer risk, there is no clear consensus regarding the optimal approach to screening patients prior to initiating the medications and/or evaluating for thyroid cancer during GLP1RA treatment. Within the context of patient cases, this review will summarize the existing data, describe ongoing controversies, and outline future areas for research regarding thyroid cancer risk with GLP1RA use.
胰高血糖素样肽1受体激动剂（GLP1RAs）迅速改变了糖尿病和肥胖症的治疗格局。基于对啮齿动物的临床前研究，人们对其使用的热情因担心其诱发C细胞肿瘤的风险而有所缓和。美国食品药品监督管理局的黑框警告建议，有甲状腺髓样癌（MTC）个人或家族病史或2A或2B型多发性内分泌肿瘤综合征（MEN2）的患者不要使用GLP1RA，为这一患者群体提供了明确的指导。然而，新出现的数据也表明，接受这些药物治疗的患者中分化型甲状腺癌（DTC）的发病率有所增加。不过，其他研究尚未证实GLP1RAs与DTC之间存在关联。由于关于甲状腺癌风险的结果相互矛盾，在开始用药前对患者进行筛查和/或在GLP1RA治疗期间评估甲状腺癌的最佳方法尚无明确共识。在患者病例的背景下，本综述将总结现有数据，描述当前的争议，并概述使用GLP1RA时甲状腺癌风险的未来研究领域。
