Another pleiotropic effect of SGLT2 inhibitors: Is it a new frontier in thyroid function regulation? - Review - read and summarize current evidence

Sep 29, 2026

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Comprehensive review proposing mechanisms for how sodium glucose cotransporter 2 (SGLT2) inhibitors may influence thyroid function. Examines bidirectional interactions between thyroid hormones and the development of diabetes and obesity, and summarizes evidence for how other antihyperglycemic drugs can alter thyroid hormone levels. Discusses potential roles of endocrine-disrupting chemicals (EDCs) in triggering thyroid disease, obesity, and diabetes, and outlines immunomodulatory and antioxidant mechanisms of flozins. Evaluates possible protective effects on autoimmune thyroid disease risk, plus broader cardiometabolic, heart, and kidney benefits; highlights hypotheses concerning Graves’ orbitopathy, myocardial protection in hyperthyroidism, thyroid cancer risk reduction, and notes limited clinical evidence regarding flozins’ impact on thyroid metabolism.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages24

Reading Time1 h 0 min

AccessFree to download

Abstract

Background

Thyroid dysfunction and diabetes links

Autoimmune thyroid disease and diabetes phenotypes

Autoimmune polyendocrine syndromes

SGLT2 inhibitors and proposed mechanisms

Szklarz et al. Thyroid Research (2026) 19:2 [https://doi.org/10.1186/s13044-025-00282-3](https://doi.org/10.1186/s13044-025-00282-3) Thyroid Research REVIEW Open Access Another pleiotropic effect of SGLT2 inhibitors: Is it a new frontier in thyroid function regulation? Michał Szklarz 1*, Katarzyna Wołos-Kłosowicz 1, Joanna Szulc 1, Jan Górny 1, Robert Modzelewski 1 and Wojciech Matuszewski 1 Abstract In our review, we present possible hypotheses that might explain how sodium glucose cotransporter 2 (SGLT2) inhibitors affect thyroid function. We describe mutual interactions between thyroid hormones and the development of diabetes and obesity. We show the effects of other antihyperglycemic drugs on thyroid hormone changes. We demonstrate how endocrine-disrupting chemicals (EDCs) may act as potential triggers for the development of thyroid disease, obesity and diabetes, and how SGLT2 inhibitors may constitute a potential protective barrier against their negative effects. We describe mechanisms of the immunomodulatory and antioxidant effects of flozins, that may reduce the risk of autoimmune thyroid disease (AITD) . We describe beneficial effects of flozins on heart and kidney function, that may also contribute to thyroid protection. Finally, we present a hypothesis of a possible favourable effect of SGLT2 inhibitors on Graves’ orbitopathy (GO), myocardial protection in hyperthyroidism, and a reduction in the risk of thyroid cancer. Aim of our work is to summarise current evidence and hypotheses regarding SGLT2 inhibitors and thyroid function. However, it should be borne in mind that there are still limited clinical evidence about impact of flozins on thyroid metabolism. Clinical trial number Not applicable. Keywords SGLT2 inhibitors, Thyroid function, AITD, Hashimoto’s disease, Graves’ disease Background Thyroid dysfunction and diabetes are among the most prevalent endocrinopathies and have been shown to share common biochemical, genetic, and hormonal pathomechanisms [1]. Perros et al. reported that thyroid disorders occur in 13.4% of patients with diabetes (range 4.8–31.4%) [2]. These disorders affect up to 31.4% of women with type 1 diabetes mellitus (DM1) and 6.9% *Correspondence: Michał Szklarz[michszklarz@gmail.com](michszklarz@gmail.com) 1Clinic of Endocrinology, Diabetology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn 10-957, Poland of men with type 2 diabetes mellitus (DM2). Autoimmune thyroid disease (AITD) is diagnosed in 3–50% of patients with DM1. Thyroid disorders are more frequent in DM1, an autoimmune disease, and include AITD such as Hashimoto’s thyroiditis and Graves–Basedow disease (GBD). Hyperthyroidism develops in 6–10% of DM1 patients during the course of GBD. In DM2, overt hypothyroidism occurs in approximately 15% of patients and subclinical hypothyroidism in 10%, while overt and subclinical hyperthyroidism are reported in 3.5% and 3% of patients, respectively [3–5]. Hypothyroidism has been diagnosed in up to 17% of pregnant women with DM1, and postpartum thyroiditis occurs three times more frequently in women with © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intende

FAQs

How do SGLT2 inhibitors potentially affect thyroid function according to the review?

The review proposes hypotheses linking SGLT2 inhibitors to effects on thyroid function through interactions between thyroid hormones and metabolic diseases, and through immunomodulatory and antioxidant mechanisms of flozins.

What is the relationship between thyroid disorders and diabetes described in the background?

The text reports that thyroid dysfunction is common in diabetes, with prevalence estimates for both type 1 and type 2 diabetes, and it highlights associations with autoimmune thyroid disease such as Hashimoto’s thyroiditis and Graves–Basedow disease.

What role might endocrine-disrupting chemicals (EDCs) play, and how could flozins counteract them?

EDCs are described as potential triggers for thyroid disease, obesity, and diabetes. The review suggests that SGLT2 inhibitors may form a protective barrier against the negative effects of EDCs, including related thyroid outcomes.

Sep 29, 2026

Uploaded by jay