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Key Findings: Large human studies across multiple countries have not found increased thyroid cancer rates in GLP-1 users The FDA warning applies to medullary thyroid carcinoma (MTC)only 3-4% of all thyroid cancers The warning exists because rodents developed C-cell tumors, but humans and rodents differ biologically Some studies show associations, but these are explained by detection bias (more monitoring = finding pre-existing nodules) The Clayman Thyroid Center (2,000+ thyroid cancer patients/year) has not seen an MTC pattern linked to GLP-1 use (or for that matter any other thyroid malignancy) Clinical Recommendations: Patients with MTC history or MEN2 should not take GLP-1 receptor agonists Patients with common thyroid cancers (papillary, follicular, Hrthle cell) should not assume GLP-1 caused them or will have an effect upon them Decisions should be individualized, weighing metabolic benefits against theoretical concerns GLP-1 therapy does not require additional thyroid monitoring Quick Reference for Clinicians Understanding the Question What Medications Are We Discussing

doi:10.1016/j.molmet.2017.03.006

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Currently, there is no direct evidence that GLP-1RA use contributes to progression of pancreatic cysts to PDAC, but this remains an important knowledge gap for future investigations considering the high prevalence of pancreatic cysts in the general population (~ 10% by age 50 and ~25% by age 70) 56