速递｜英国三大内分泌权威组织解答：GLP-1 受体激动剂与甲状腺癌的四大疑问

Core Viewpoint - The joint statement from UK endocrine and thyroid associations indicates that GLP-1 receptor agonists show clear metabolic and cardiovascular benefits in treating type 2 diabetes and obesity, but concerns regarding their safety related to thyroid cancer, particularly medullary thyroid carcinoma, need clarification based on existing evidence [3][4]. Summary by Sections Question 1: Does GLP-1 receptor agonists increase the risk of thyroid cancer? - The core conclusion of the joint statement is that current evidence does not support a causal link between GLP-1 receptor agonists and thyroid cancer. Clinical studies and follow-ups have not observed a clinically significant increase in thyroid cancer risk shortly after starting the medication [4]. - Initial concerns stemmed from animal studies where long-term exposure to certain GLP-1 receptor agonists led to changes in thyroid C cells and an increased incidence of medullary thyroid carcinoma. However, these findings have not been consistently replicated in human studies [4]. - High-quality population studies have not shown a substantial increase in thyroid cancer risk associated with the use of GLP-1 receptor agonists [4]. Question 2: Can patients with hyperthyroidism, hypothyroidism, benign nodules, or goiter use GLP-1 receptor agonists? - The joint statement suggests that common thyroid diseases such as hyperthyroidism, hypothyroidism, benign thyroid nodules, or goiter do not constitute special restrictions for using GLP-1 receptor agonists. Existing systematic reviews and clinical data do not indicate a significant increase in thyroid function abnormalities or nodule-related risks in these patients [6]. Question 3: Can patients with differentiated thyroid cancer use GLP-1 receptor agonists? Does it increase recurrence risk? - There is currently no evidence that GLP-1 receptor agonists increase the recurrence risk of differentiated thyroid cancer, which includes papillary, follicular, and anaplastic thyroid cancers. For patients who have been treated and are in follow-up, these medications can be used if they provide clear benefits in weight control, blood sugar management, or cardiovascular metabolism [7]. Question 4: Can patients with medullary thyroid carcinoma or MEN2-related risk populations use GLP-1 receptor agonists? - The joint statement aligns with existing medication warnings, advising against the use of GLP-1 receptor agonists in individuals with a history of medullary thyroid carcinoma, known pathogenic RET gene mutations, or a family history of multiple endocrine neoplasia type 2 (MEN2). In rare cases where strong medical reasons exist, careful decision-making should occur within a multidisciplinary team [8]. Summary Points - Overall, the consensus from authoritative organizations in the UK endocrine and thyroid fields indicates that GLP-1 receptor agonists remain a safe and effective treatment option for most populations, with current evidence not supporting a clear causal link to thyroid cancer. In cases with clear indications, there should be no blind cessation or refusal of use due to generalized concerns [9]. - Caution is warranted for a small number of high-risk populations, particularly those related to medullary thyroid carcinoma or MEN2, who should adhere to contraindications or use the medication cautiously within a multidisciplinary framework [10].