Article: What's my risk? Wegovy and thyroid cancer
TLDR
The baseline risk for thyroid cancer in someone who does not have risk factors (goiter, nodules, family history, previous radiation exposure, obesity, and genetic syndromes) is somewhere around 1-2% (absolute risk).
Obesity increases the relative risk by around 30%, which corresponds to an absolute risk around 2.6% (2% x 1.3= 2.6%).
Semaglutide is estimated to increase the risk of thyroid cancer (potentially overestimating the risk given concerns about the French data set) by around 58% (relative risk), which corresponds to an absolute risk around 3.2%.
While there is clearly an increased risk of thyroid cancer with Semaglutide use, the absolute risk remains low. We don't have enough high quality research to know if chronic use (over years) leads to increased risk over time.
*Note that these are estimates based on available data meant to put risk into perspective. More research is needed to more accurately calculate this risk.
There's a saying in medicine that if a medication has no side effects or risks, then does it really even do anything?
So what does this have to do with Semaglutide (Wegovy, Ozempic)? One side effect is the black box warning for increased risk of thyroid cancer which is a pretty serious concern.
So what is the average risk for thyroid cancer and how does adding Semaglutide change this?
An article in Diabetes Care (2022) reviewed the French National database looking at the risk of thyroid cancer in people living with Type 2 Diabetes that were taking a GLP-1 (the class of medication that includes semaglutide) (1). They found a 58% increased risk for thyroid cancer and 78% increased risk for a specific subtype of thyroid cancer called Medullary thyroid cancer (1).
While these numbers sound large and scary, we also see an increased incidence of thyroid cancer in people living with obesity of around 26-30% (2). And these are relative risks, not absolute. There is also concern that the French data set may have been flawed as they found more thyroid cancers (percentage wise) than we typically see at baseline in the US... around 3 times higher, as Thompson & Stürmer of Harvard pointed out (5).
When we think about thyroid cancer, the absolute risk is somewhere around 1-2% according to CDC SEER data (4). Medullary thyroid cancer (without a family history) represents around 1-2% of thyroid cancers, which is a very small subset (3).
What increases the risk for thyroid cancer? Goiter, nodules, family history, previous radiation exposure, obesity, and genetic syndromes (5).
What do I think? Diet and lifestyle changes remain the cornerstone of obesity management and while medications have a role, they do come with risks. There is no question that semaglutide increases the risk of thyroid cancer. That said, the absolute risk remains low.
If you're looking to jumpstart your weight loss through sustainable therapeutic lifestyle interventions +/- medication, then you've come to the right place. Schedule your free new patient consult today.
References
GLP-1 Receptor Agonists and the Risk of Thyroid Cancer. Bezin et al. Diabetes Care. (2022). https://doi.org/10.2337/dc22%2D1148
Impact of Overweight and Obesity on US Papillary Thyroid Cancer Incidence Trends (1995–2015). Kitahara. Journal of the National Cancer Institute. (2020). https://doi.org/10.1093/jnci/djz202
Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma. Wells et al. Thyroid Journal. (2015). https://doi.org/10.1089/thy.2014.0335
SEER Data on Thyroid Cancer. CDC. (accessed 11/2023). https://seer.cancer.gov/statfacts/html/thyro.html
Putting GLP-1 RAs and Thyroid Cancer in Context: Additional Evidence and Remaining Doubts. Thompson and Stürmer. Harvard University.https://doi.org/10.2337/dci22-0052
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