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Background  Glucagon‐like peptide‐1 receptor agonists, such as dulaglutide, exenatide and liraglutide, are approved to treat Type 2 diabetes mellitus. Although these drugs provide substantial glycaemic control, studies in rodents have prompted concerns about the development of medullary thyroid carcinoma. These data are reflected in the  US  package insert, with boxed warnings and product labelling noting the occurrence of these tumours after clinically relevant exposures in rodents, and contraindicating glucagon‐like peptide‐1 receptor agonist use in people with a personal or family history of medullary thyroid carcinoma, or in people with multiple endocrine neoplasia type 2. However, there are substantial differences between rodent and human responses to glucagon‐like peptide‐1 receptor agonists. This report presents the case of a woman with pre‐existing medullary thyroid carcinoma who exhibited no significant changes in serum calcitonin levels despite treatment with dulaglutide 2.0 mg for 6 months in the Assessment of Weekly AdministRation of  LY 2189265 [dulaglutide] in Diabetes‐5 clinical study ( NCT 00734474).    Case report  Elevated serum calcitonin was noted in a 56‐year‐old woman with Type 2 diabetes mellitus at the 6‐month discontinuation visit in a study of long‐term dulaglutide therapy. Retroactive assessment of serum collected before study treatment yielded an elevated calcitonin level. At 3 months post‐study, calcitonin level remained elevated; ultrasonography revealed multiple bilateral thyroid nodules. Eventually, medullary thyroid carcinoma was diagnosed; the woman was heterozygous positive for a germline   RET   proto‐oncogene mutation.    Conclusion  The tumour was not considered stimulated by dulaglutide therapy because calcitonin remained stable throughout.

No calcitonin change in a person taking dulaglutide diagnosed with pre‐existing medullary thyroid cancer