Incretin Therapies and Thyroid Cancer Risk: GLP-1 Drugs vs DPP-4 Inhibitors Compared | Research

The takeaway

Analysis investigated the association between incretin-based therapies (GLP-1 agonists and DPP-4 inhibitors) and thyroid cancer, comparing risk profiles between the two drug classes.

Class comparison
Thyroid cancer risk compared between GLP-1 agonists and DPP-4 inhibitors to determine if risk is class-specific or shared across incretin therapies

What the researchers found

Comparative analysis of thyroid cancer associations between GLP-1 agonists and DPP-4 inhibitors provides class-specific risk data for incretin-based therapies.

Why it matters

Distinguishing thyroid cancer risk between GLP-1 drugs and DPP-4 inhibitors informs safer prescribing choices, especially for patients with thyroid concerns.

The numbers in context

Study used thyroidectomy + 2 or more separate thyroid cancer diagnosis codes as the definition of thyroid cancer. U.S. Medicare population with type 2 diabetes.

How the study worked

Analysis comparing thyroid cancer incidence between GLP-1 receptor agonist and DPP-4 inhibitor users.

Who was studied

U.S. Medicare beneficiaries with type 2 diabetes using incretin-based or SGLT-2 inhibitor therapies

What this study cannot tell us

Observational data with potential confounders. Thyroid cancer is rare, limiting statistical power. Different patient populations may use different drug classes.

How to read the evidence

Moderate evidence: comparative observational analysis of a clinically important safety question.

When this study was published

Published in 2025. Addresses ongoing thyroid safety concerns with incretin drugs.

The bigger picture

This comparative approach is valuable because GLP-1 drugs and DPP-4 inhibitors raise GLP-1 signaling through different mechanisms. If thyroid risk differs between classes, it reveals whether the concern is about GLP-1 receptor activation level, duration, or a drug-specific property.

Questions still open

Is the thyroid cancer signal stronger with GLP-1 drugs than DPP-4 inhibitors?
Does the level of GLP-1 receptor activation correlate with thyroid risk?
Should thyroid cancer history influence the choice between GLP-1 drugs and DPP-4 inhibitors?

Common questions

Which is safer for my thyroid: GLP-1 drugs or DPP-4 inhibitors?

This study compared thyroid cancer associations between the two classes. GLP-1 drugs carry a boxed warning from rodent data, while DPP-4 inhibitors do not. The comparative analysis helps clarify whether this risk difference is real in humans.

Should I avoid GLP-1 drugs if I have thyroid issues?

GLP-1 drugs should be avoided if you have personal or family history of medullary thyroid cancer or MEN2 syndrome. For other thyroid conditions, discuss with your endocrinologist — the risk in humans appears very low based on current evidence.

Read the original research

Investigating the association between incretin-based therapies and thyroid cancer incidence among US Medicare beneficiaries with diabetes.

BMJ open diabetes research & care, 13(5)

View on PubMed ↗Publisher’s paper ↗

Citation

Acheampong, Clement O; Buse, John B; Klein, Klara R; Kim, Lawrence T; Evron, Joshua; Kahkoska, Anna R; Thompson, Caroline A; Wang, Tiansheng; Pate, Virginia; Leese, Peter; Stürmer, Til. (2025). Investigating the association between incretin-based therapies and thyroid cancer incidence among US Medicare beneficiaries with diabetes.. BMJ open diabetes research & care, 13(5). https://doi.org/10.1136/bmjdrc-2025-005090