Endocrinology

GLP‑1RAs and thyroid outcomes differ by glycemic status in a large real‑world cohort

In a multicenter EHR target‑trial emulation with up to 5 years follow-up, GLP‑1RA exposure linked to reduced thyroid dysfunction in prediabetes and type 1 diabetes. Among people with type 2 diabetes, GLP‑1RAs were associated with modestly higher autoimmune thyroiditis and nontoxic goiter, especially with obesity or absence of hypertension. No increased thyroid cancer risk was observed in any glycemic group. These observational results support individualized monitoring but cannot prove causality. 1

Individualized supportive interventions preserved functional well‑being and high endocrine‑therapy adherence

In a prospective phase II study of 40 premenopausal women starting combined endocrine therapy, patient‑selected interventions improved functional well‑being by 1.65 points/year. Emotional, social, physical, endocrine symptom, and perceived cognitive domains remained stable over follow‑up. Overall adherence to endocrine therapy was high at 92.5%. Younger age (<35 years) predicted less favorable outcomes, suggesting targeted support for younger patients. 2

Methodologic guidance for real‑world GLP‑1RA evidence generation

A NIDDK workshop synopsis reviewed strengths and limits of EHRs, registries, and claims for GLP‑1RA research. Speakers emphasized pragmatic trials and target‑trial emulation to strengthen causal inference and generalizability. Key concerns included data quality, selection bias, and incomplete ascertainment of medications and outcomes. Careful design and analytic transparency are required before using RWD to change clinical practice or policy. 3