Can You Take GLP-1 Medications If You Have Hashimoto’s or Thyroid Cancer?

Is your thyroid the reason you’re hesitating to start a GLP-1 medication?

GLP-1 medications have changed the way we treat obesity and type 2 diabetes. But for anyone with a thyroid condition, they’ve also created a lot of anxiety, especially when headlines mention thyroid cancer, nodules, or hormone disruption.

In this episode of Hormones & Hope, endocrinologist Dr. Chhaya Makhija breaks down the science behind GLP-1 medications and thyroid health by answering the five most commonly Googled questions on this topic:

✅ Do GLP-1 medications like Ozempic or Wegovy cause thyroid cancer?

✅ Can I take GLP-1 medications if I have hypothyroidism or Hashimoto’s?

✅ Do GLP-1 medications affect thyroid hormone levels or absorption?

✅ Do GLP-1 medications cause thyroid nodules or swelling?

✅ Are GLP-1 medications safe if thyroid cancer runs in my family?

 No fear-mongering. No oversimplification. Just clear, evidence-based guidance to help you make informed decisions with your physician. 

This episode is especially helpful if you have hypothyroidism, Hashimoto’s disease, thyroid nodules, or a personal or family history of thyroid cancer and are considering GLP-1 therapy.

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Transcript

00:00
As an endocrinologist, this is one of the common topics that is GLP-1 and  thyroid questions, which are very misunderstood  and we are going to bring some clarity with science and take away those fears  or unnecessary anxiety.  I am going to break down about what is the thyroid cancer contraindication with GLP-1  versus  where you need to be cautious. And again, we do this with science.  So,

00:27
If you have hypothyroidism, you have Hashimoto's, if you're worried about thyroid nodule, if there is a family history of thyroid cancer or you have a history of thyroid cancer  and are looking for use of GLP-1 medications either for  type 2 diabetes or for obesity treatment, this episode, my friend, is for you.  Welcome to Hormones and Hope,  a podcast where we bridge science and wellness  to help transform your health.

00:55
I'm your host, Dr. Chhaya Makhija,  or you can call me Dr. Chhaya,  a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care.  Each week we dive into the powerful intersection of clinical medicine  and real life lifestyle strategies  to help you feel stronger,  live longer,  and show up as your most vibrant self inside and out.  So let's get empowered. Hi everyone.

01:23
Welcome to another episode on hormones and hope and we are in January 2026. This is your host Dr. Chhaya Makhesha and today is another exciting episode with you and me looking at GLP-1 medications and thyroid health. Yes, my friend, purely thyroid health and it's not just going to be a discussion but top five highly searched questions relevant to thyroid and the use of GLP-1 medications like ozempic, VigoV, manjaroseb, bound and so on.

01:53
Here I am with you with those five questions. Now, before we start, I recorded another episode which was published last week and that was the top five questions relevant to GLP-1. So if you haven't tuned in to that episode, hit pause and go listen to that episode because it is really going to take you a step further into understanding GLP-1 medications with your most common questions. And then this is in relevance to thyroid health.

02:23
All right, as an endocrinologist, this is one of the common topics that is GLP-1 and  thyroid questions, which are very misunderstood  and we are going to bring some clarity with science and take away those fears or unnecessary anxiety. I am going to break down about what is the thyroid cancer contraindication with GLP-1  versus where you need to be cautious. And again, we do this with science. So,

02:51
If you have hypothyroidism, you have Hashimoto's, if you're worried about thyroid nodule, if there is a family history of thyroid cancer or you have a history of thyroid cancer  and are looking for use of GLP-1 medications either for type 2 diabetes or for obesity treatment, this episode, my friend, is for you. Let's talk facts, let's talk science, and let's drill into it. I have five commonly searched questions for GLP-1 and thyroid health.

03:20
So I'm going to read these questions out loud to you so you know which one is really relevant for you today. Does a GLP-1 medication like ozempic bigovimandjaro really cause thyroid cancer  and can I take it if I have SgF thyroid cancer? Number two, can I take GLP-1 medications if I have hypothyroidism or Hashimoto's?  Number three, m

03:44
Do GLP-1 medications affect thyroid hormone absorption or thyroid hormone levels?  Number four, does GLP-1 medication cause thyroid nodules or thyroid swelling? And number five, are these medications, that is Ozempic, VigoV, Manjaro, Zep-bound GLP-1 medications, are these medications safe if I have a family history of thyroid cancer? So let's directly jump into question number one, is that

04:14
Do these medications, that is, does GLP-1 medication like ozempic, Vigo V. Manjaro, Zepbond and others cause thyroid cancer?  And I'm going to give you a simple answer as well as a nuanced answer. Now, what do we know about thyroid cancer?  If you  are  already having an existing thyroid cancer or prior history, or if you had family history of thyroid cancer  and  you have another diagnosis, which could be

04:43
treated with GLP-1 medication, then my friend, let's dive into it.  Now, GLP-1 medications are contraindicated, purely contraindicated, in patients with personal or family history of medullary thyroid cancer,  M-U-D-U-L-L-A-R-I, medullary thyroid cancer. And one of these conditions, which is genetic, is called multiple endocrine neoplasia syndrome type 2, NEN type 2.

05:11
that is an inheritance in the family where these individuals tend to have medullary thyroid cancer. So there is any family history in regards to this specific thyroid cancer, GLP-1 medications are contraindicated. Now, why is that? We have a black box warning on all the medications which are specifically GLP-1 or GLP-1 and GIP. What we've seen that this is  all based on rodent studies showing C-cell tumors  and

05:40
We have C cells  in our thyroid gland and C cell tumors  are leading to medullary thyroid cancer and that's why it's a black box warning because we've seen those cases in rodents in animals.  Now the differentiated thyroid cancer. So if you have other family history or personal history of thyroid cancer which comes into the category of differentiated thyroid cancer which is papillary thyroid cancer, follicular thyroid cancer and then many sub

06:09
sections to it, in those scenarios there is no evidence that it is directly a causal factor for causing these kind of thyroid cancer as the differentiated form. Again, we don't have much of an evidence and it is not clear if there is any direct co-relationship between taking GLP-1 medications and inducing any of these types of thyroid cancer. So, there is no established contraindication for

06:37
use of GLP-1 medications in patients with history of differentiated thyroid cancer like papillary thyroid carcinoma  and we don't have any evidence which suggests that there is a direct correlation or contraindication. So the best way would be have a discussion with your endocrinologist or with your physician about

07:00
this specific question and this specific difference between medullary versus thyroid cancer. So I wouldn't shut the doors for my patients who have history of papillary thyroid cancer, be it personal or family.  And if they have a medical indication to  use GLP-1 medication and they would like to,  this is the discussion I would have in regards to the safety, what we know in science, the contraindications.  So now you know.

07:28
If you're specifically asking about thyroid cancer and GLP-1, be more specific in terms of understanding what kind of thyroid cancer. And is it differentiated? it the anaplastic origin? Is it just the medullary version where we have clear idea of medullary thyroid cancer being a black box warning for humans as a contraindication for GLP-1 receptor agonist? All right. Now, that being said, we will move on to other thyroid disorders.

07:56
So our next question, where it's going to be question number two, is relevant to hypothyroidism at Hashimoto's. So I usually have this question posed several times because as an endocrinologist, thyroid autoimmune condition  is the most common autoimmune condition in the endocrine world.  And hypothyroidism or autoimmune-induced hypothyroidism is the most common thyroid disease that we see or encounter.

08:22
Similarly, as endocrinologist, this was the first specialty using and prescribing GLP-1 medications in 2005 onwards. And that's why knowing about these medications in the realm of thyroid and its use in other indications, we are going to  come to that answer. Can I take GLP-1 medications if I have hypothyroidism or Hashimoto's thyroid disease? The simple answer is yes, you can. Now, this is very commonly searched.

08:51
question, especially in women because in women we have a more or a higher incidence and prevalence of Hashimoto's disease or even primary hypothyroidism. Now let's get into the science or dig into what is exactly happening in hypothyroidism and GLP-1 receptor agonist in terms of how they work. Hypothyroidism per se, when it's treated,

09:16
or you're on medications with thyroid hormone is not a contraindication to GLP-1 therapy. Now, there are some studies which show that  if individuals are taking levothyroxine medication and they're on GLP-1 medications, there might be some changes in the levothyroxine absorption or...

09:36
The thyroid hormone absorption,  is related to the changes in the gastric emptying or how our stomach contracts when we are on GLP-1 medication, it's called peristalsis. But there is no direct evidence that it will cause someone to become hypothyroid or it is going to impact the levels, specifically TSH. For you to know clinically that if you have hypothyroidism  and you are taking GLP-1 medication or you're a physician prescribing GLP-1 medication,

10:06
One thing to keep in check is that  if a patient loses 10, 15, 20 pounds over time and they're already on treatment for hypothyroidism with the thyroid hormone replacement, when we lose weight for any reason, it's very important to reassess the thyroid hormone requirements because they might need adjustment.  And before patients have symptoms, I usually suggest to my patients that if you're losing

10:36
10-15  pounds  and you are feeling good, you're on the GLP-1 medication, it's a good time to check the thyroid hormone levels again in three months or so, so that we are able to adjust the thyroid hormone dose and this will also avoid or prevent excess thyroid hormone in your system when you are in that journey of weight loss.  So it is not a direct impact of the medication that I'm talking about, but the indirect.

11:04
benefit that you are receiving with the right weight loss with the improvement in body composition, where your thyroid hormone requirements when you have hypothyroidism may need to be adjusted or titrated,  or there will be a possibility that the labs will change  and you may need an adjustment on your thyroid hormone dosing. Okay, now with that being said, it is also very important that untreated hypothyroidism

11:33
If you're not getting the treatment for hypothyroidism  and your TSH levels are high, especially for primary hypothyroidism, untreated can cause you to have weight gain, can cause you to have low energy, can cause you to have lethargy. So it's very important that that is taken care of. You identify the cause of weight gain treated before starting GLP-1 medication. All right, my friends.

12:02
Now, when you've learned about thyroid cancer, GLP-1, hypothyroidism,  and Hashimoto's and GLP-1, our number three question, which is most commonly asked, is do these medications, that is, do GLP-1 medications like Ozempic, Vigo, V-Manjaro, Zepp-Bound, and so on, affect the thyroid hormone levels  or the absorption?  I touched based on the thyroid hormone absorption in question number

12:31
or answer number two and let's look into the absorption aspect of it. Now as we all are aware if you're thinking about GLP-1 medication you should have read about how it works, right? So it is working on the gut, it is working on your stomach, it is affecting the contractility or the peristalsis or how your stomach, your gastric emptying is working so there is a delay in that gastric emptying. When you take levothyroxine you are

13:01
taking it most of the times empty stomach with a glass full of water and most of the absorption occurs in the stomach. So as discussed, usually we don't see a massive shift or a problem or a discrepancy with the levothyroxine absorption when you're on GLP-1. But if you have other scenarios where you're taking an antiacid, where you're experiencing heartburn, if you're taking calcium and other supplements,

13:29
hour or two hours after levothyroxine and your stomach contraction is slower because of GLP-1 medication, there might be impaired absorption. That is, your levothyroxine may not get absorbed adequately or any of the thyroid hormone that you're on because those supplements or that anti-acid is also still in the stomach or the food that you're eating one hour, two hours after taking the levothyroxine that

13:59
might be still present in your stomach and that might affect the acidity or the pH of the stomach and that might lead to some changes in the absorption of leotiroxine. Now if it's happening on a daily basis, then like I suggested, the best thing is to get your thyroid hormone  tests done within those three months as you're experiencing weight loss as well. So there is no right or wrong answer for that. Does it directly affect the absorption? That is, does GOP1 directly affect

14:27
the absorption of the levothyroxine or the thyroid hormone levels.  Usually it shouldn't, but there are so many scenarios, so many contributing factors affecting the absorption of levothyroxine. It's a picky hormone where it wants to be independent in the stomach and it doesn't get adequately absorbed if you're on antacids, calcium, other supplements  or a proton pump inhibitor like omeprazole, pantoprazole. And if you're experiencing heartburn, you're already on

14:58
medications like pepsi, famotidine, ranitidine, then it might impact your thyroid hormone levels. So if you're a physician prescribing GLP-1 and thyroid hormone, or if you're a patient who is planning to or on GLP-1 and thyroid hormone, it is a good thing to check your thyroid hormone levels within those eight weeks or 12 weeks after you've initiated GLP-1. So...

15:22
Question 2 and question 3 were related to hypothyroidism and the treatment of hypothyroidism and impact of GLP-1 medications. So now we talk about question number 4, is, can GLP-1  medications  cause thyroid nodules or thyroid swelling? Now, since we're talking about thyroid, you all know that thyroid exists in your neck.  And if you're noticing a lump,

15:48
It may not just necessarily be a thyroid lump. If you're experiencing on the sides, it could be a lymph node. So here we are specifically talking about a thyroid nodule and thyroid swelling, not necessarily a neck lump. When we have thyroid nodules  and these are either  biopsy proven benign, then there is no contraindication that you cannot take GLP-1 medications for the medical indications that you need.

16:18
GLP-1  medications by itself, we don't have any data, any evidence that it is going to lead to thyroid nodules.  I would recommend to again look at the answer number one where we talked about thyroid cancer  and  different types of thyroid cancer. So when you have a thyroid nodule, it could be a two millimeter nodule, it could be a two centimeter nodule. There is a vast difference.

16:46
Most of the thyroid nodules are usually benign, but they are different sizes, shapes, their appearances vary on ultrasounds, and that's why it's important that you see an expert, an endocrinologist, if you have a thyroid nodule, get  the right management treatment or a follow-up, or it's also called as surveillance if  there is a concern before you decide to start GLP-1 medication.

17:13
We don't have direct evidence where GLP-1 medications  are causing thyroid nodules or even thyroid swelling. In general, you also want to remember thyroid nodules are just common. They're common in the thyroid gland and there is no recommendation from our guidelines to do a screening thyroid ultrasound if you're taking GLP-1.  A simple clinical examination done by your physician is  usually adequate.

17:43
So by itself,  I wouldn't build on the fear or anxiety that  GLP-1 medications are leading to a thyroid nodule or a thyroid swelling.  One important necessary step that I would highly recommend that if you're going on GLP-1 medications because you have diabetes or there is insulin resistance  and you're preventing type 2 diabetes and you have obesity  or other predisposing risk factors,

18:09
that make you eligible to take these medications, it's very important that you get your basic testing done, which also includes a thyroid hormone evaluation, specifically thyroid stimulating hormone and if it's needed a free T4. So you have a baseline understanding of what your thyroid functions are before you're considering these medications. And that's just a simple screening process, not just because

18:36
you're starting GLP-1, but it is actually one of the important hormones that we tend to test in the metabolic world. Also for annual women's screening, it is so crucial that you all should be aware as an adult as to what your thyroid hormone levels were. If not, request your primary care physician or your physician to at least add that in your annual checkup in case of  either any symptoms.

19:02
or if you are dealing with a metabolic condition like obesity, diabetes, fatty liver disease and so on. Okay, so that was  nuanced but a short answer for your question about GLP-1 medications, cause thyroid nodules or swelling. We haven't seen that in science that it directly can cause thyroid nodules or swelling.  And for specifically thyroid cancer, I already answered that in answer number one. All right, my friends.

19:29
So we'll keep this episode short and sweet. the most important question here  is question number five, what are the contraindications for GLP-1 medication? is  absolute no-no for you  to consider GLP-1 receptor agonist when you're having a discussion with your treating physician, as well as what you should be aware of. So number one  is a personal or family history of medullary carcinoma, which we covered in answer number one.

19:57
including one of the conditions which is called multiple endocrine neoplasia. And there are different types where it encompasses medullary thyroid cancer, pregnancy, right, breastfeeding. If you already have a lot of hypersensitivity or some reactions to GLP-1 receptor agonist in the past, that is definitely considered. Now, where do you need extra vigilance, extra caution would be

20:22
if you already have a diagnosis of gastroparesis or if you already have a diagnosis of delayed gastric emptying. As an endocrinologist, I see patients when they are coming to me with really complicated, uncontrolled type 1 or type 2 diabetes, mellitus, where they already have neuropathy. Many of the times they tend to have autonomic neuropathy where their nerves in the gut are affected and that leads to

20:47
slowing of their stomach peristalsis and they have delayed gastric emptying in those scenarios, that's autonomic neuropathy. So  it's very important to know what their baseline is at that particular time when you're discussing GLP-1 receptor agonist. History of pancreatitis, it's usually an absolute contraindication in certain scenarios, but if there was a reason for pancreatitis and now that's resolved and not existent anymore, again, with your evaluation, a good

21:16
discussion between you and your physician to figure out the risk and benefits. There are other conditions like proliferative diabetes or diabetic retinopathy, is retinopathy  related to complicated uncontrolled type 2 diabetes. We have studies more specifically for semaglutide where it's very important to just get a good retina examination if someone already has

21:40
complicated diabetes to make sure that they don't have like active bleeding vessels or proliferation going on  as uh introduction of GLP-1 receptor agonists in these patients with diabetes might just worsen their retinopathy. Then comes if you're using again these medications in concert with other medications which can drop blood sugars in patients with diabetes mellitus, then overlapping

22:06
More medications, of course, will lead to a risk of hypoglycemia, low blood sugar. So that is another  caution and supervision and discussion that is needed, but it's not an absolute contraindication. The first four that I discussed would be the common contraindications that you will see in these list of medications.  So now we've covered five important questions relevant to GLP-1 medications and your thyroid health.

22:32
If you have more questions relevant to GLP-1 or if you're experiencing something and you've read something or you need it to know about a specific research article,  send me a DM, send me an email  or reach out to my office or my website, unifiedendocrinecare.com. And I would love to review these questions, these articles  and who knows, come up  and share the science-based facts and answers with you at another episode.

23:02
I really appreciate you listening to our episode and sending me your questions, your feedback, as well as amazing love that comes from our listeners. And we appreciate all of that. In the next few episodes, we are going to have fun topics on osteoporosis and real patient stories who are actually coming and sharing  their journey of osteoporosis and lot more other specialists as we head into 2026 Strong with Science and

23:31
solutions for you.  Until then, it's Dr. Mekija. Take care of yourself.  Thanks for hanging out with me on hormones and hope.  If you've loved this episode,  me a favor, hit subscribe, share it with someone you care about  and drop a review if you're feeling generous.  Want more tools to support your hormones and health?  Head over to unifiedendocrinecare.com.  We've got free guides, resources and more waiting for you.  Until next time,

23:59
Stay curious, stay kind to your body and keep your hormones happy.