SGLT-2 inhibitors do not decrease tsh levels despite weight reduction, unlike GLP-1 agonists

Mikulas Kosak; Tomas Burger; Ivan Kuzko; Monika Nyvltova; Johana Venerova; Tomas Pelcl; Jan Palecek; Lucie Pagova; Zdarska Denisa Janickova

doi:10.1530/endoabs.110.EP856

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Endocrine Abstracts (2025) 110 EP856 | DOI: 10.1530/endoabs.110.EP856

ECEESPE2025 ePoster Presentations Metabolism, Nutrition and Obesity (164 abstracts)

SGLT-2 inhibitors do not decrease tsh levels despite weight reduction, unlike GLP-1 agonists

Mikulas Kosak ¹ , Tomas Burger ¹ , Ivan Kuzko ¹ , Monika Nyvltova ¹ , Johana Venerova ¹ , Tomas Pelcl ¹ , Jan Palecek ¹ , Lucie Pagova ¹ & Denisa Janickova Zdarska ¹

Author affiliations

¹Military University Hospital Prague, 1st Faculty of Medicine, Charles University, Department of Medicine, Prague, Czech Republic

JOINT966

Introduction: TSH (Thyroid Stimulating Hormone) elevation in obesity is a recognized phenomenon. While various mechanisms have been proposed, a clear pathogenic mechanism remains undefined. Weight reduction is typically accompanied by a decrease in TSH levels, particularly with GLP-1 receptor agonist treatment. This study aimed to compare the effects of SGLT-2 inhibitors and GLP-1 receptor agonists on TSH levels in relation to weight reduction in patients with type 2 diabetes mellitus (T2DM).

Patients and Methods: This retrospective analysis included T2DM patients who started treatment either with SGLT-2 inhibitors or GLP-1 receptor agonists at our centre. Biochemical and anthropometric data were collected before treatment and after 12 months of therapy. The aim was to compare the effects of both drug classes on body weight, HbA_1c, and TSH levels.

Results: Data from 90 patients treated with SGLT-2 inhibitors and 38 treated with GLP-1 receptor agonists were analysed. In the SGLT-2 group, 66 were men and 24 were women, with a mean age of 65.7 years (range 34–88). In the GLP-1 group, 27 were men and 11 were women, with a mean age of 61 years (range 36–74). In the SGLT-2 group, mean BMI decreased from 34.57 ± 3.6 to 32.8 ± 3.55 (p < 0.001) after 12 months. HbA_1c decreased from 65.49 ± 8.15 mmol/mol to 55.91 ± 6.73 mmol/mol (p < 0.001). TSH levels decreased from 2.16 ± 0.82 mIU/L to 1.96 ± 0.6 mIU/l, but the change was not statistically significant (P =0.0968). In the GLP-1 group, mean BMI decreased from 32.93 ± 4.80 to 30.48 ± 5.36 (p < 0.001). HbA_1cdecreased from 59.44 ± 10.25 mmol/mol to 47.69 ± 7.80 mmol/mol (p < 0.001). TSH levels decreased from 3.42 mIU/L to 2.25 mIU/L (p < 0.001).

Conclusion: Both GLP-1 receptor agonists and SGLT-2 inhibitors led to significant reductions in BMI and HbA_1c. However, a significant decrease in TSH levels was observed only with GLP-1 treatment, suggesting that its impact on metabolism may be broader and more complex, potentially involving mechanisms beyond weight reduction alone.