Abstract：
OBJECTIVE: Glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy has demonstrated an increased risk of thyroid C-cell hyperplasia and C-cell tumors in rodents. Due to this risk, a boxed warning for this drug class exists for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. There is a lack of data regarding any possible effect of GLP-1 RA therapy on serum thyroid levels. The objective of this case report is to describe a case of suppressed thyroid stimulating hormone levels after initiation of a subcutaneous semaglutide in a post-total thyroidectomy patient managed with levothyroxine in order to highlight the need for closer monitoring of these patients and further research in this area.
METHODS: The patient described in the case underwent a total thyroidectomy in 2015 with stable thyroid hormone replacement requirements with levothyroxine for 5 years until the initiation and titration of subcutaneous semaglutide. The reduction in thyroid stimulating hormone (TSH) after starting GLP-1 RA therapy necessitated a 25 percent dose reduction of levothyroxine from her original dose.
CONCLUSIONS: This patient experienced suppressed TSH levels following initiation and titration of subcutaneous semaglutide. The etiology of these changes may be related to the direct effects of GLP-1 RA therapy on TSH levels, changes in absorption related to delayed gastric emptying rates, secondary to GLP-1 RA-associated weight loss, or a combination of these proposed mechanisms. It may be prudent to exercise more frequent monitoring of medications that require weight-based dosing and those with a narrow therapeutic index when initiating and titrating GLP-1 RA-based therapies and is an area of potential study.
METHODS: The patient described in the case underwent a total thyroidectomy in 2015 with stable thyroid hormone replacement requirements with levothyroxine for 5 years until the initiation and titration of subcutaneous semaglutide. The reduction in thyroid stimulating hormone (TSH) after starting GLP-1 RA therapy necessitated a 25 percent dose reduction of levothyroxine from her original dose.
CONCLUSIONS: This patient experienced suppressed TSH levels following initiation and titration of subcutaneous semaglutide. The etiology of these changes may be related to the direct effects of GLP-1 RA therapy on TSH levels, changes in absorption related to delayed gastric emptying rates, secondary to GLP-1 RA-associated weight loss, or a combination of these proposed mechanisms. It may be prudent to exercise more frequent monitoring of medications that require weight-based dosing and those with a narrow therapeutic index when initiating and titrating GLP-1 RA-based therapies and is an area of potential study.
摘要：
目的：胰高血糖素样肽-1受体激动剂（GLP-1RA）治疗表明啮齿动物甲状腺C细胞增生和C细胞肿瘤的风险增加。由于这种风险,对于有甲状腺髓样癌或多发性内分泌瘤变综合征2型的个人或家族史的患者,存在该类药物的黑框警告.缺乏关于GLP-1RA治疗对血清甲状腺水平的任何可能影响的数据。本病例报告的目的是描述一例在接受左旋甲状腺素治疗的甲状腺全切除术后患者开始皮下苏美鲁肽后，甲状腺刺激激素水平受到抑制的病例，以强调需要对这些患者进行更密切的监测和进一步的研究。
方法：该病例中描述的患者于2015年接受了甲状腺全切除术，需要使用左旋甲状腺素进行稳定的甲状腺激素替代治疗5年，直到开始并滴定皮下苏美鲁肽。开始GLP-1RA治疗后，促甲状腺激素（TSH）的减少需要将左甲状腺素的剂量从原始剂量减少25％。
结论：该患者在开始和滴定皮下司马鲁肽后，TSH水平受到抑制。这些变化的病因可能与GLP-1治疗对TSH水平的直接影响有关。与胃排空率延迟相关的吸收变化，继发于GLP-1RA相关的体重减轻，或这些提出的机制的组合。在开始和滴定基于GLP-1RA的治疗时，对需要基于体重的给药和治疗指数狭窄的药物进行更频繁的监测可能是谨慎的，并且是潜在研究领域。
方法：该病例中描述的患者于2015年接受了甲状腺全切除术，需要使用左旋甲状腺素进行稳定的甲状腺激素替代治疗5年，直到开始并滴定皮下苏美鲁肽。开始GLP-1RA治疗后，促甲状腺激素（TSH）的减少需要将左甲状腺素的剂量从原始剂量减少25％。
结论：该患者在开始和滴定皮下司马鲁肽后，TSH水平受到抑制。这些变化的病因可能与GLP-1治疗对TSH水平的直接影响有关。与胃排空率延迟相关的吸收变化，继发于GLP-1RA相关的体重减轻，或这些提出的机制的组合。在开始和滴定基于GLP-1RA的治疗时，对需要基于体重的给药和治疗指数狭窄的药物进行更频繁的监测可能是谨慎的，并且是潜在研究领域。
