Can You Take Ozempic If You Have a Thyroid Condition?
Key takeaways:
You can safely take Ozempic (semaglutide) if you have the most common types of hypothyroidism and hyperthyroidism.
But you shouldn’t take Ozempic if you or a family member have a history of thyroid cancer or multiple endocrine neoplasia type 2 (MEN2).
It’s not clear if taking Ozempic long term increases the risk of developing thyroid cancer.
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Ozempic (semaglutide) is an injectable medication that can help treat Type 2 diabetes mellitus. A different injectable formulation of semaglutide — Wegovy — can be used as a weight management treatment.
These medications are powerful tools, but they can also lead to side effects, like pancreatitis and an upset stomach. You may have also heard that Ozempic and Wegovy can cause thyroid problems and that people with a history of thyroid conditions should avoid these medications. But that’s not always the case.
Can you take Ozempic if you have thyroid cancer?
Maybe. Thyroid cancer isn’t just one condition. There are four main types of thyroid cancer:
Papillary
Follicular
Medullary
Anaplastic
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So far, researchers think it’s safe to take Ozempic if you have a history of papillary or follicular thyroid cancer.
But, if you have a history of medullary thyroid cancer, don’t take Ozempic or Wegovy. You also shouldn’t take these medications if someone in your immediate family has a history of medullary thyroid cancer.
Talk with your healthcare team if you’re currently receiving treatment for thyroid cancer. You may not be able to take Ozempic or Wegovy if you’re receiving certain treatments, like chemotherapy, immunotherapy, or targeted therapy.
How does Ozempic increase the risk of thyroid cancer?
Ozempic targets the glucagon-like peptide-1 (GLP-1) receptors throughout the body. These receptors are found on certain cells in the gastrointestinal tract, the brain, and thyroid.
In the thyroid, GLP-1 receptors are found on cells called parafollicular cells (C-cells). When Ozempic and similar medications stimulate the GLP-1 receptor, it may cause C-cells to transform. This can lead to medullary thyroid cancer. Studies in rodents show that long-term exposure to semaglutide is linked to tumor formation in C-cells.
These studies weren’t done in humans. But rodent GLP-1 receptors are similar enough to human GLP-1 receptors that scientists started investigating whether humans would also be prone to thyroid tumors while taking Ozempic.
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The results in humans haven’t been as clear.
A well-designed study of human data, which included almost 50 trials and studies, didn’t show that people who took semaglutide had higher rates of thyroid cancer when compared to people taking other common diabetes medications.
But one large study showed that people taking GLP-1 agonists had higher rates of all types of thyroid cancer.
Other researchers caution that the link between thyroid cancer and GLP-1 agonists remains an association. That means there’s no definitive proof that GLP-1 agonists cause the increased rates of cancer. Other factors, like smoking, other health conditions, and genetics, may play a role, too.
So, right now, it’s not clear if GLP-1 agonists will definitely lead to cancer transformation in thyroid C-cells. But there’s a reason to tread cautiously, especially if you’re at higher risk for developing medullary thyroid cancer.
What are the chances of getting thyroid cancer from Ozempic?
It’s not clear. There isn’t enough research to answer this question about people with an average risk of developing thyroid cancer.
But, for specific groups of people, the answer is more clear. This includes people with a history of multiple endocrine neoplasia type 2 (MEN2) and people at higher risk for developing medullary thyroid cancer.
MEN2 is a group of genetic conditions that increase risk for developing medullary thyroid cancer. 95% to 100% of people with MEN2 will develop medullary thyroid cancer. This group of people shouldn’t take Ozempic or other GLP-1 agonists. The potential risks from these medications are too high.
The same is true for others at high risk for developing medullary thyroid cancer and people with a prior history of medullary thyroid cancer. Until the debate is fully settled, the risks associated with GLP-1 agonists outweigh the benefits.
Can you take Ozempic if you have an underactive thyroid?
Yes. Ozempic doesn’t affect the cells responsible for making thyroid hormones. So, it’s safe to take Ozempic if you have a history of hypothyroidism (underactive thyroid). People can have hypothyroidism for several reasons including:
Autoimmune thyroiditis (Hashimoto’s disease)
Pituitary dysfunction
Congenital absence of thyroid gland
Thyroid surgery or ablation
You can still take Ozempic if you have an underactive thyroid from one of these conditions.
Can you take Ozempic if you have an overactive thyroid?
Yes. Again, Ozempic doesn’t affect the cells that make thyroid hormones. So, it’s safe to take Ozempic if you have hyperthyroidism (overactive thyroid).
Can you take Ozempic if you’re on thyroid medication?
You can take Ozempic if you’re taking these thyroid medications:
Levothyroxine (Euthyrox): Levothyroxine is the most commonly prescribed thyroid medication. It’s a lab-made version of thyroid hormone and is used to treat hypothyroidism. There’s some evidence that Ozempic impacts levothyroxine blood levels. Your endocrinologist may ask you to get more frequent bloodwork to check your thyroid function and determine you need to adjust your levothyroxine dose while taking Ozempic.
Desiccated thyroid hormone (Armour Thyroid): Desiccated thyroid hormone is another form of thyroid hormone replacement, but it isn’t FDA-approved. There are no drug interactions between desiccated thyroid hormone and Ozempic. But your endocrinologist may want to check your blood work more often to make sure that you don’t need to adjust your dose while taking Ozempic.
Methimazole (Tapazole): Methimazole is a medication that’s used to treat hyperthyroidism. There are no drug interactions between methimazole and Ozempic.
Propylthiouracil: Propylthiouracil is a medication used to treat hyperthyroidism. It’s the first-choice treatment for people with hyperthyroidism who are also pregnant. There are no drug interactions between Ozempic and propylthiouracil.
The bottom line
Ozempic and GLP-1 receptor agonists are increasingly prescribed for treatment of diabetes and obesity, and show promising data in treatment of other chronic conditions. If you have hypothyroidism or hyperthyroidism, Ozempic is likely safe to take. The medications used to treat these conditions don’t interact with Ozempic. You shouldn't take Ozempic if you have a personal or family history of medullary thyroid cancer or MEN2.
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References
Bezin, J., et al. (2023). GLP-1 receptor agonists and the risk of thyroid cancer. Diabetes Care.
Bjerre Knudsen, L., et al. (2010). Glucagon-like peptide-1 receptor agonists activate rodent thyroid C-cells causing calcitonin release and C-cell proliferation. Endocrinology.
Nagendra, L., et al. (2023). Semaglutide and cancer: A systematic review and meta-analysis. Diabetes & Metabolic Syndrome.
National Cancer Institute. (n.d.). Thyroid cancer — patient version.
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Hashimoto's disease.
Novo Nordisk A/S. (2023). Ozempic (semaglutide) injection, for subcutaneous use [package insert].
Thompson, C. A., et al. (2023). Putting GLP-1 RAs and thyroid cancer in context: Additional evidence and remaining doubts. Diabetes Care.
