Personal or family history of medullary thyroid carcinoma

Personal or family history of medullary thyroid carcinoma Writing it up because I had to work it out twice and would rather nobody else did.

Asking about a population rather than about a person.

The published trials in this class mostly enrolled a fairly specific group, and the questions here frequently come from people well outside it. I would like to understand what the honest position is when someone falls outside the studied population: not "it is fine" and not "there is no data", but what the reasoning actually looks like.

Allergy to the specific compound: true allergy is rare but possible. Any prior allergic reaction to the same compound or to structurally similar peptides warrants caution.

Severe hepatic impairment: less is known than for kidney disease. Extreme caution or contraindication depending on the specific degree of impairment.

Picking up the opening post: that is the part I would want checked first.

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

Pregnancy: these compounds are not approved for pregnancy. The potential risks outweigh potential benefits. Planning windows and washout (several months) are the standard approach.

I read post #5 twice before replying, because I had assumed the opposite.

History of pancreatitis: these compounds can rarely trigger pancreatitis. History of pancreatitis increases relative risk. That is a relative contraindication, not absolute, but requires monitoring.

This follows post #5 rather than contradicting it.

Diabetic retinopathy complications: a signal for this was noted in SUSTAIN 6. Current evidence is mixed. The risk is not zero and some caution is appropriate in people with baseline retinopathy.

Disordered eating history: appetite suppression can trigger relapse in people with history of anorexia, bulimia, or other eating disorders. This is a relative contraindication requiring specialist input.

Severe renal impairment (eGFR <15): these compounds are renally cleared and accumulate in severe kidney disease. Risk-benefit is unfavourable without dose adjustment.

post #10 is right about the mechanism and I think understates the practical bit.

Gastroparesis or severe delayed gastric emptying: these compounds slow gastric emptying. Pre-existing severe gastroparesis can be worsened. That is a relative contraindication depending on baseline severity.

Concurrent insulin or sulfonylureas: not an absolute contraindication but requires dose adjustment and close monitoring for hypoglycemia. The combination is used with caution, not avoided.

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

I read post #12 twice before replying, because I had assumed the opposite.

Severe hepatic impairment: less is known than for kidney disease. Extreme caution or contraindication depending on the specific degree of impairment.