甲状腺结节患者，使用司美格鲁肽等GLP-1RA药物的指南

Core Viewpoint - The article discusses the implications of GLP-1 receptor agonists (GLP-1RAs) in the treatment of thyroid nodules, emphasizing the need for careful monitoring and specific guidelines for patients with a history of thyroid cancer or related conditions [4][6][12]. Summary by Sections GLP-1RA and Thyroid Cancer - There is currently no conclusive evidence linking GLP-1 receptor agonists to thyroid cancer [4] - Patients with benign thyroid nodules can use GLP-1RAs, but those with grade 4 or higher nodules require regular monitoring of serum calcitonin levels [6] Classification of Thyroid Nodules - Benign nodules account for approximately 95% of all thyroid nodules, while malignant nodules represent about 5% [7] - The risk of malignancy in nodules is influenced by factors such as appearance, size, growth rate, and patient demographics [7] Management Strategies for Thyroid Nodules - For benign nodules, treatment is generally not required, and regular follow-up is recommended [8] - Malignant or suspicious nodules typically require surgical intervention based on ultrasound risk stratification [8] TI-RADS Classification and Cancer Risk - The TI-RADS classification system helps assess the nature of thyroid nodules, with levels ranging from 0 (no nodules) to 6 (confirmed malignancy) [9][10][11] - TI-RADS 2 indicates benign nodules with less than 2% malignancy risk, while TI-RADS 5 indicates a high risk of malignancy between 85% and 100% [10] Medullary Thyroid Carcinoma (MTC) - MTC accounts for 2% to 3% of all thyroid cancers and can be sporadic or familial [12][13] - Patients with a history of MTC or multiple endocrine neoplasia type 2 (MEN2) are generally advised against using GLP-1RAs due to increased cancer risk [6] Oral Semaglutide and Clinical Trials - Oral semaglutide (Rybelsus) has shown significant efficacy in lowering HbA₁c by 1.0%-1.5% and reducing weight by approximately 4 kg over 52 weeks [14] - The PIONEER studies indicate that oral semaglutide is effective in the Chinese population, demonstrating statistical advantages over sitagliptin [16] Future Market Potential for Small Molecule GLP-1 - Eli Lilly's small molecule GLP-1 agonist, Orforglipron, shows promising results with an average weight loss of 7.3 kg and HbA₁c reduction of about 1.5% over 40 weeks [18] - If approved, small molecule oral formulations could significantly enhance the accessibility and application of GLP-1 therapies [18] Regulatory Developments - Novo Nordisk has submitted a marketing application for oral Wegovy (oral semaglutide 25 mg) for chronic weight management, which could become the first oral GLP-1 approved for weight loss [19]