ArticleThe Journal of clinical endocrinology and metabolism2026
Patterns of TSH test after GLP-1 RAs initiation in patients on levothyroxine: a trial emulation study.
Article in The Journal of clinical endocrinology and metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Patterns of TSH test after GLP-1 RAs initiation in patients on levothyroxine: a trial emulation study.The Journal of clinical endocrinology and metabolism · 2026Article
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Authors and funding
8 authors.
Funding
Abstract
contextGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for type 2 diabetes and obesity and can lead to substantial weight loss. In patients taking levothyroxine, weight loss can reduce thyroid hormone requirements and potentially associated adverse effects. Thyroid-stimulating hormone (TSH) monitoring is essential but unclear whether thyroid function is routinely reassessed after GLP-1 RAs initiation.
objectiveExamine the changes in the timing of TSH testing after GLP-1 RAs.
designRetrospective cohort study emulating a target trial using Medicare from January 1, 2011, to December 31, 2020. The primary analysis followed an intention-to-treat approach. Patients were matched 1:1 using propensity scores. Logistic regression models and informed by least absolute shrinkage operator variable selection were used.
settingThe 15% sample of U.S. Medicare fee-for-service claims data. PATIENTS OR OTHER
participantsAdults aged ≥65 years with type 2 diabetes on a stable levothyroxine dose at baseline. INTERVENTION(S): Initiation of GLP-1 RAs vs initiation/ongoing use of sodium-glucose cotransporter-2 inhibitors (SGLT-2is). MAIN OUTCOME MEASURE(S): TSH testing during follow-up.
resultsAmong 5370 matched patients, the mean age was 73.2 years. 71.6% were women, and 87.1% were White. Approximately 83.0% of patients in both treatment groups receive a TSH testing within a 1-year follow-up. The mean time to TSH testing was approximately 130.5 days for both groups.
conclusionTSH testing patterns did not differ between GLP-1 RAs and SGLT-2is, despite the greater likelihood of requiring levothyroxine dose adjustment associated with weight loss seen with GLP-1 RA therapy. Given levothyroxine's widespread use, this gap suggests missed opportunities for timely and weight-responsive thyroid monitoring.
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