Patterns of TSH Testing After GLP-1 RA Initiation in Patients on Levothyroxine: A Trial Emulation Study
Chen Y, Du F, Singh Ospina NM, Brito JP, Shao H, Liu Q, McCoy RG, Jiao T
Summary
Among 5,370 matched Medicare patients aged ≥65 with type 2 diabetes on stable levothyroxine, TSH testing patterns did not differ between GLP-1 RA initiators and SGLT-2 inhibitor users, despite the greater weight loss seen with GLP-1 RAs that could necessitate levothyroxine dose adjustments. Approximately 83% of both groups received TSH testing within 1 year, with mean time to testing of ~130 days.
Clinical Significance
This study identifies a critical clinical gap: prescribers are not adjusting thyroid monitoring frequency to account for GLP-1 RA-induced weight loss, which can reduce levothyroxine requirements and risk iatrogenic subclinical hyperthyroidism. Clinicians prescribing GLP-1 RAs to patients on levothyroxine should implement more proactive TSH monitoring protocols.
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