GLP-1 Medications May Not Increase Hypothyroidism Risk Compared to DPP-4 Inhibitors | Research

The takeaway

A real-world cohort study from Saudi Arabia found no increased risk of hypothyroidism with GLP-1 receptor agonists compared to DPP-4 inhibitors.

No increased risk
Hypothyroidism incidence similar between GLP-1 RA and DPP-4 inhibitor users

What the researchers found

GLP-1 receptor agonist use was not associated with increased hypothyroidism incidence compared to DPP-4 inhibitor use in Saudi Arabian adults.

Why it matters

Preclinical thyroid safety signals had raised concerns about GLP-1 RAs. Real-world evidence showing no increased hypothyroidism risk helps reassure patients and clinicians.

How the study worked

Active-comparator, new-user cohort study using the Saudi Real-World Evidence Research Network (SRWEN) from 2016-2023.

What this study cannot tell us

Observational design cannot prove causation; Saudi Arabian population may not be generalizable to all populations; follow-up duration may miss very late-onset effects.

How to read the evidence

Active-comparator cohort study — strong observational design with new-user approach, but still subject to unmeasured confounding.

When this study was published

Published 2026. Data from 2016-2023 covers the period of rapid GLP-1 RA adoption.

The bigger picture

As GLP-1 RA prescriptions surge globally, ongoing pharmacovigilance through real-world evidence studies like this is essential to confirm that preclinical safety signals don't translate to clinical risk.

Questions still open

Do longer follow-up periods reveal different thyroid outcomes?
Are specific GLP-1 RAs associated with different thyroid safety profiles?

Common questions

Can GLP-1 drugs cause thyroid problems?

Animal studies raised concerns, but this large real-world study found no increased risk of hypothyroidism in people taking GLP-1 medications compared to those taking similar diabetes drugs.

Should I get my thyroid checked while on a GLP-1 medication?

Based on current evidence, routine thyroid monitoring beyond standard care is not specifically recommended for GLP-1 RA users, but discuss any concerns with your doctor.

Read the original research

The Risk of Hypothyroidism With the Use of GLP-1 Receptor Agonists in Saudi Arabia.

Pharmacoepidemiology and drug safety, 35(1), e70315

View on PubMed ↗Publisher’s paper ↗

Citation

Alfakhri, Almaha; Almadani, Ohoud; Alroba, Raseel; Alrwisan, Adel; Alshaya, Omar; Albogami, Yasser. (2026). The Risk of Hypothyroidism With the Use of GLP-1 Receptor Agonists in Saudi Arabia.. Pharmacoepidemiology and drug safety, 35(1), e70315. https://doi.org/10.1002/pds.70315