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Implications of Glucagon-like Peptide-1 Receptor Agonists on Thyroid Function and Thyroid Nodules: A Drug Target

Zhijun Zhang1, Jingyun Yang1, Ling Gao1

  • 1Department of Endocrinology & Metabolism, Renmin Hospital of Wuhan University, Wuhan, China.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|July 24, 2025
PubMed
Abstract

Insights

Glucagon-like peptide-1 (GLP-1) receptor agonists may decrease free thyroxine (fT4) levels and potentially increase thyroid nodule size in diabetic patients. While generally safe for thyroid health, these effects warrant monitoring during treatment.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Diabetology

Background:

  • Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used for type 2 diabetes management.
  • Conflicting evidence exists regarding their impact on thyroid function and nodule development.
  • This study aims to clarify the relationship between GLP-1 receptor agonists and thyroid health in diabetic individuals.

Purpose of the Study:

  • To investigate the effects of GLP-1 receptor agonists on thyroid function and nodule progression in patients with diabetes.
  • To assess the safety profile of GLP-1 receptor agonists concerning thyroid diseases.

Main Methods:

  • A Mendelian randomization study was performed to analyze the genetic association between GLP-1 receptor agonist activity and thyroid diseases.
  • A cohort study compared 169 diabetic patients (control vs. GLP-1 receptor agonist treatment group) over 12 months.
  • Thyroid function tests, nodule diameters, and TI-RADS classifications were evaluated at baseline and after treatment.

Main Results:

  • Mendelian randomization indicated that GLP-1 receptor agonists decrease free thyroxine (fT4) levels within the normal range.
  • The cohort study observed increased nodule diameter in both control and GLP-1 receptor agonist groups after 12 months.
  • In the GLP-1 receptor agonist group, TI-RADS levels increased, and fT4 levels decreased significantly.

Conclusions:

  • Twelve-month treatment with GLP-1 receptor agonists appears relatively safe for thyroid health in diabetic patients.
  • Potential risks include a decrease in fT4 levels and possible nodule growth or progression.
  • No clear evidence suggests superiority over other antidiabetic treatments regarding thyroid outcomes.
Keywords:
GLP-1 receptor agonistsMendelian randomizationthyroid functionthyroid nodulestype 2 diabetes

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