Thyroid Cancer Risk

GLP-1 receptor agonist use for more than 1 year may increase thyroid cancer risk

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Adults with type 2 diabetes who use a GLP-1 receptor agonist for more than 1 year may have an increased risk for thyroid cancer, according to findings published in Diabetes Care.

“Our results suggest that thyroid cancer risk should be considered with GLP-1 receptor agonists, particularly in patients treated for 1 to 3 years,” Jean-Luc Faillie, MD, PhD, professor and head of the department of medical pharmacology and toxicology at Montpellier University Hospital and University of Montpellier in France, and colleagues wrote. “Complementary pharmacovigilance analysis with use of the worldwide adverse drug reactions database provided consistent results.”

Risk for thyroid cancer among adults with type 2 diabetes using GLP-1 receptor agonists
Data were derived from Bezin J, et al. Diabetes Care. 2022;doi:10.2337/dc22-1148.

Researchers conducted a case-control analysis of data from France’s national health care insurance system database. People with type 2 diabetes using GLP-1 receptor agonists, DPP-IV inhibitors or multiple therapies combining metformin, sulfonylureas, repaglinide, alpha-glucosidase inhibitors or thiazolidinediones from 2006 to 2018 were included. Researchers obtained incident cases of thyroid cancer from 2014 to 2018 through hospital diagnoses and medical procedures associated with thyroid cancer. People with thyroid cancer were matched with up to 20 control participants without thyroid cancer by age, sex and diabetes duration. A lag time of 6 months before cancer diagnosis was used to reduce the risk of reverse causation. Researchers identified adults who used GLP-1 receptor agonists and DPP-IV inhibitors and obtained the duration of use in the 6 years before the lag time.

The study included 3,746,672 people with type 2 diabetes, of whom 4,466 developed thyroid cancer. After excluding those with a history of cancer, researchers analyzed data from 2,562 adults with thyroid cancer and 45,184 matched controls without thyroid cancer.

Before the lag time, 12% of the thyroid cancer group and 9.6% of the control group used GLP-1 receptor agonists, with more than 80% in both groups using liraglutide (Victoza, Novo Nordisk). Those currently using a GLP-1 receptor agonist had a higher risk for thyroid cancer compared with those not currently using the medication (adjusted HR = 1.46; 95% CI, 1.23-1.74). Those who used a GLP-1 receptor agonist for 1 to 3 years (aHR = 1.58; 95% CI, 1.27-1.95) or more than 3 years (aHR = 1.36; 95% CI, 1.05-1.74) also had a higher risk for thyroid cancer than non-users.

Adults using DPP-IV inhibitors for more than 3 years had an increased risk for thyroid cancer compared with nonusers (aHR = 1.19; 95% CI, 1.04-1.35), but no other significant associations with the drug class were observed.

Researchers also conducted an analysis using data from the WHO’s pharmacovigilance database from April 28, 2005, to March 1, 2021. Data were collected to estimate associations between GLP-1 receptor agonist use and the risk of differential reporting of thyroid cancer compared with other diabetes drugs, excluding insulin. Associations were estimated using proportional reporting ratio.

In the analysis, 606 spontaneous reports of thyroid cancer with GLP-1 receptor agonist use were found. Disproportionate reporting of any thyroid cancer (proportional reporting ratio, 30.5; 95% CI, 25.1-37.2) and medullary thyroid cancer (proportional reporting ratio, 28.7; 95% CI, 16.1-51.1) were observed with GLP-1 receptor agonist use.

“Clinicians should be aware of this potential risk [for thyroid cancer] in initiating a GLP-1 receptor agonist and carefully monitor exposed patients, especially in the presence of other risk factors for thyroid cancer,” the researchers wrote.

Thyroid cancer risk increases with hysterectomy

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Among postmenopausal women, the risk for thyroid cancer is increased with hysterectomy regardless of oophorectomy status, according to recently published data.

Use of exogenous estrogen was associated with lower risk for thyroid cancer in women who had undergone hysterectomy without oophorectomy, particularly for those with long duration use of hormone therapy, researchers wrote.

Juhua Luo, PhD, associate professor in the department of epidemiology and biostatistics at the School of Public Health, Indiana University Bloomington, and colleagues evaluated data from the Women’s Health Initiative on 127,566 women aged 50 to 79 years who were enrolled between 1993 and 1998 to determine the relationships between hysterectomy, bilateral salpingo-oophorectomy and thyroid cancer incidence. Follow-up was a mean 14.4 years.

At baseline, 36.7% of women had undergone hysterectomy, and 55% of them had bilateral salpingo-oophorectomy. Through follow-up, 344 participants developed thyroid cancer.

An increased risk for thyroid cancer was related to hysterectomy, regardless of ovarian status (HR = 1.46; 95% CI, 1.16-1.85). A similar increased risk for thyroid cancer was found in participants with hysterectomy alone and participants with hysterectomy plus bilateral salpingo-oophorectomy compared with participants without hysterectomy.

The risk for thyroid cancer was not associated with HT use in participants without hysterectomy and participants with hysterectomy plus bilateral salpingo-oophorectomy, but HT use in participants with hysterectomy alone was associated with a significantly lower risk for thyroid cancer (HR = 0.47; 95% CI, 0.28-0.78). This was especially pronounced in participants using HT for 10 or more years (HR = 0.24; 95% CI, 0.11-0.52).

Compared with participants without hysterectomy, participants with hysterectomy had an increased risk for thyroid cancer (HR = 1.78; 95% CI, 1.33-2.37).

“Our large prospective study observed that hysterectomy regardless of oophorectomy status was associated with increased risk of thyroid cancer among postmenopausal women,” the researchers wrote. “[HT] use was associated with lower or no risk of thyroid cancer. These findings did not support that exogenous estrogen is a risk factor and estrogen deprivation is a protective factor for thyroid cancer. Our study suggests that when deciding to remove the uterus for benign conditions, possible increased risk of thyroid cancer should be considered.” – by Amber Cox

Chamomile Tea Tied to Lower Thyroid Cancer Risk

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Herbal teas can be a rich source of beneficial compounds like polyphenols and flavonoids, which have antioxidant and anti-inflammatory properties.

Simply sipping a cup here and there, without leading an accompanying healthy lifestyle, may not make a major difference in your health, but among people in Greece, many of whom follow a healthy Mediterranean diet, herbal tea turned out to be quite protective against cancer.

Three types of herbal tea stood out for their anti-cancer potential, but out of the varieties (chamomile, sage, and mountain teas), chamomile took center stage, outshining the other two in terms of cancer prevention.

Drinking Chamomile Tea May Reduce Thyroid Cancer Risk by Up to 80 Percent

Rates of thyroid cancer are significantly lower in Greece than they are in the US and Europe. In Greece, about 1.6 per every 100,000 people are diagnosed with thyroid cancer each year, compared to rates of 13.2 and 5.2 per 100,000 in the US and Europe, respectively.1

In addition to the fresh vegetables and healthy fats upon which the Mediterranean diet is centered, Athens residents often enjoy herbal tea, and the study found that the more chamomile tea consumed, the lower the risk of thyroid cancer became.

Specifically, those who drank chamomile tea two to six times a week had a 70 percent lower risk of developing thyroid abnormalities while those who drank it regularly for 30 years had an 80 percent lower risk.2 According to the study:

“Although in the last decade several studies have addressed the protective role of black and green tea on several diseases, including cancer, there are only few and controversial studies on the effect of tea on benign and malignant thyroid diseases.

…Our findings suggest for the first time that drinking herbal teas, especially chamomile, protects from thyroid cancer as well as other benign thyroid diseases.”

Chamomile Contains the Anti-Cancer Flavonoid Apigenin

It’s likely that naturally occurring flavonoids, such as apigenin, are responsible for some of chamomile’s anti-cancer effects. Apigenin, which is found in chamomile as well as in celery, parsley, fruits, and other vegetables and herbs, slowed cancer growth and shrank cancerous tumors in animal studies.

When mice that were implanted with cells of a particularly deadly, fast-growing human breast cancer were treated with apigenin, the cancerous growth slowed and the tumors shrank.3

Blood vessels feeding the cancer tumors also shrank and restricted nutrient flow to the tumor cells, starving them of the nutrients needed to spread. A study conducted in 2011 also showed similarly promising results; when rats with breast cancer were treated with apigenin, they developed fewer tumors and had significant delays in tumor formation.

Again in 2013, apigenin was shown to block the ability of breast cancer cells to inhibit their own deaths. Interestingly, the compound was also found to bind to 160 proteins in the human body, which suggests it has far-reaching health effects (unlike pharmaceutical drugs, which typically only have one specific target). The researchers explained:4

“…in contrast to small-molecule pharmaceuticals designed for defined target specificity, dietary phytochemicals affect a large number of cellular targets with varied affinities that, combined, result in their recognized health benefits.”

7 Health Benefits of Chamomile

This soothing herb has a long history of traditional use, including by the father of medicine himself, Hippocrates. Chamomile is typically used in the form of infusions, liquid extracts, or essential oils made from the plant’s fresh or dried flower heads.

Beyond potentially playing a role in thyroid-cancer prevention, chamomile, which comes from the Camellia sinensis plant, has multiple pharmacological actions, including:5

Antibacterial Antifungal Anti-inflammatory
Antispasmodic Anti-ulcer Antiviral
Sedative effects

In addition, chamomile may help with the following conditions:6

1. Wounds and Insect Bites

Chamomile is one of the most soothing herbs of all, whether used in a tea or applied to your skin. It is rich in the bioflavonoids apigenin, luteolin, and quercetin, and was valued by ancient Greeks, Romans, and Egyptians as a salve for wound treatment.

Research shows rats that drank chamomile water healed faster than those who did not, possibly due to the herb’s anti-inflammatory, antimicrobial, and antioxidant effects.7 Chamomile has even been shown to cause complete wound healing faster than corticosteroids.8

2. Diabetes

Chamomile tea may be a particularly good choice for diabetics, as one animal study showed it lead to significant decreases in blood glucose levels among diabetic rats, while also lowering the risk of diabetic complications including diabetic neuropathy (nerve damage), cataracts, vision damage, and kidney damage.9

According to Molecular Medicine Reports:10

“Studies suggest that chamomile ameliorates hyperglycemia and diabetic complications by suppressing blood sugar levels… [and] increasing liver glycogen storage…”

3. Muscle Spasms, Stress, and Anxiety Relief

Chamomile tea raises your levels of glycine, which helps calm muscle spasms.11 Glycine is also a nerve relaxant, which may explain why chamomile is also effective for stress and anxiety relief.12 Traditionally, chamomile tea is also recommended for soothing menstrual cramps.

4. Sleep

Chamomile has sedative effects that may help with sleep, which is why chamomile tea is often sipped before bed. One study found that people with insomnia who took a chamomile supplement had improvements in daytime functioning and potential benefits on sleep measures as well.13According to Molecular Medicine Reports:14

“Chamomile is widely regarded as a mild tranquillizer and sleep-inducer. Sedative effects may be due to the flavonoid, apigenin that binds to benzodiazepine receptors in the brain.

Studies in preclinical models have shown anticonvulsant and CNS [central nervous system] depressant effects respectively… 10 cardiac patients are reported to have immediately fallen into a deep sleep lasting for 90 minutes after drinking chamomile tea.”

5. Digestive Upset

As a muscle relaxant, chamomile may help to soothe an upset stomach and may even be beneficial for irritable bowel syndrome (IBS).15 Molecular Medicine Reports noted:16

“Chamomile is used traditionally for numerous gastrointestinal conditions, including digestive disorders, ‘spasm’ or colic, upset stomach, flatulence (gas), ulcers, and gastrointestinal irritation. Chamomile is especially helpful in dispelling gas, soothing the stomach, and relaxing the muscles that move food through the intestines.”

6. Hemorrhoids

Chamomile has powerful anti-inflammatory effects, and a chamomile ointment may help improve hemorrhoids. Chamomile can also be used in tincture form as part of a sitz bath for hemorrhoid relief.17

7. Skin Irritation

Chamomile’s soothing effects don’t stop at your mood. Due to its anti-inflammatory effects, chamomile is often used to treat skin irritations such as sunburn and rashes, and it may help with conditions such as eczema as well. In one eczema study, chamomile was found to be about 60 percent as effective as hydrocortisone cream.18

Is Chamomile an All-Around Health Tonic?

Chamomile is one of the most popular herbal teas worldwide. In the US alone, up to 1 million pounds of chamomile are imported each year, about 90 percent of which is used for teas.19 As is the case with most herbs, it appears chamomile is useful for a wide variety of health complaints while providing broad healing effects. In Germany, chamomile is approved for use to reduce skin swelling and stomach cramps.20

The American Botanical Council notes there are studies supporting chamomile’s “use for sleep enhancement, alleviation of diarrhea in children, colic relief in infants, wound healing, reduction of mucositis in patients undergoing radiation treatment, and relief of eczema symptoms.”21 Chamomile also has significant benefits for emotional and mental health, offering relief from “nervous tension… nervous excitability in children… [and] stress conditions where digestion is a problem.”22 It’s even been found to improve some symptoms of attention-deficit hyperactivity disorder (ADHD) in teens.23 In addition, Molecular Medicine Reports noted:24

“Chamomile has been used as an herbal medication since ancient times, is still popular today and probably will continue to be used in the future because it contains various bioactive phytochemicals that could provide therapeutic effects. Chamomile can help in improving cardiovascular conditions, stimulate immune system, and provide some protection against cancer.”

Suggestions and Dosages for Chamomile Use

If you enjoy chamomile tea, it is a fine beverage to enjoy prior to bed or after a stressful day. You may also enjoy a cup after a meal. If you’d like to prepare a chamomile infusion to relieve gastrointestinal complaints, Germany’s Commission E recommends the following recipe:25

“150 ml boiling water poured over approximately 3g dried flower and steeped, covered, for 5–10 minutes, 3–4 times daily between meals for gastrointestinal complaints.”

The American Botanical Council also offers the following recipes for using chamomile in dried flower form for a variety of ailments:26

  • Bath additive: 50g dried flower added per 10 liters (ca. 2.5 gallons) water as a bath for ano-genital inflammation [i.e. hemorrhoids]
  • Gargle: 100 ml boiling water poured over 3-10g dried flower and steeped, covered, for 5-10 minutes. The tea infusion is used as a wash or gargle for inflammation of the mucous membranes of the mouth and throat.
  • Inhalation: 100 ml boiling water poured over 3-10g dried flower and steeped, covered, for 5-10 min, 1-3 times daily. Steam vapor inhaled for inflammation of the upper respiratory tract.
  • Poultice: Semisolid paste or plaster containing 3-10% of flower heads.

While chamomile has an excellent safety record with very few contraindications, if you are allergic to ragweed pollen, chrysanthemums, asters, yarrow flower, arnica, or marigold flower, you may also be allergic to chamomile. In addition, if you’re taking blood-thinning medication such as warfarin (Coumadin), potential interactions have been reported, although this remains controversial.