Saxenda and Graves disease can coexist, but careful consideration is essential. Saxenda (liraglutide 3.0 mg) is a GLP-1 receptor agonist licensed in the UK for weight management in adults with obesity or overweight with comorbidities. Graves disease, the most common cause of hyperthyroidism, affects thyroid hormone production and metabolic rate. Whilst Saxenda is not contraindicated in patients with thyroid conditions, those with Graves disease require stable thyroid function, regular monitoring, and coordinated care between their GP, endocrinologist, and prescribing clinician to ensure safe and effective treatment.

What Is Saxenda and How Does It Work?

Saxenda (liraglutide 3.0 mg) is a prescription medicine licensed in the UK for weight management in adults. Per the UK SmPC, liraglutide 3.0 mg is licensed for adults with BMI ≥30 kg/m², or ≥27 kg/m² with at least one weight-related comorbidity; use with reduced-calorie diet and increased physical activity. It belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists, which were originally developed for type 2 diabetes management but have proven effective for weight loss at higher doses.

The medication works by mimicking a naturally occurring hormone called GLP-1, which is released from the intestines after eating. Liraglutide acts on specific receptors in the brain, particularly in areas that regulate appetite and food intake. By activating these receptors, Saxenda helps to:

• Reduce appetite and increase feelings of fullness

• Slow gastric emptying, which prolongs satiety after meals (this effect may attenuate over time)

• Modulate reward pathways associated with food intake

Saxenda is administered as a once-daily subcutaneous injection, typically starting at a low dose (0.6 mg) and gradually increasing over five weeks to the maintenance dose of 3.0 mg daily. This gradual titration helps minimise common gastrointestinal side effects such as nausea and vomiting.

NICE TA664 recommends liraglutide for a narrower group, within a specialist weight management service and for a maximum of 2 years. Treatment should be discontinued if patients do not lose at least 5% of their initial body weight after 12 weeks at the maintenance dose.

Important safety considerations include: avoid use in pregnancy and during breastfeeding; do not use with other GLP-1 receptor agonists or other weight-loss medicines; limited data in people aged ≥75 years; and caution is advised in renal impairment.

Understanding Graves Disease and Thyroid Function

Graves disease is an autoimmune condition and the most common cause of hyperthyroidism (overactive thyroid) in the UK, affecting approximately 1-2% of women (about 0.5% of the overall population), with women being significantly more affected than men. In this condition, the immune system produces antibodies called thyroid-stimulating immunoglobulins (TSIs) that bind to and activate thyroid-stimulating hormone (TSH) receptors on the thyroid gland, causing excessive production and release of thyroid hormones.

The thyroid gland, located in the neck, produces two main hormones: thyroxine (T4) and triiodothyronine (T3). These hormones regulate numerous bodily functions, including:

• Metabolic rate and energy expenditure

• Heart rate and cardiovascular function

• Body temperature regulation

• Weight management and appetite

• Mood and cognitive function

When thyroid hormone levels are elevated in Graves disease, patients typically experience symptoms such as unintentional weight loss, increased appetite, heat intolerance, tremor, palpitations, anxiety, and fatigue. Some patients also develop Graves ophthalmopathy (eye disease) or pretibial myxoedema (skin changes).

Diagnosis involves blood tests showing suppressed TSH with raised free T4 and/or T3, which supports hyperthyroidism. TSH receptor antibody (TRAb) testing supports Graves disease diagnosis; a thyroid uptake scan may be considered if serology is negative or presentation is atypical. Treatment options in the UK include antithyroid medications (carbimazole or propylthiouracil), radioactive iodine therapy, or thyroid surgery.

Many patients develop hypothyroidism (underactive thyroid) after radioiodine treatment or thyroidectomy and require lifelong thyroid hormone replacement with levothyroxine. Regular monitoring of thyroid function is essential for all patients with Graves disease, regardless of treatment status.

Can You Use Saxenda If You Have Graves Disease?

The relationship between Saxenda and Graves disease requires careful consideration, though there is no official contraindication to using liraglutide in patients with thyroid conditions, including Graves disease. The Saxenda Summary of Product Characteristics (SmPC) approved by the MHRA does not list Graves disease or hyperthyroidism as contraindications to treatment.

However, the prescribing information does include important thyroid-related warnings. The UK SmPC includes a warning about thyroid C-cell tumours seen in rodents; the relevance to humans is uncertain. Be vigilant for neck lumps, dysphagia, dyspnoea or hoarseness; routine calcitonin/ultrasound screening is not recommended.

For patients with Graves disease specifically, several factors influence the decision to prescribe Saxenda:

• Current thyroid status: Patients should have well-controlled thyroid function before initiating weight management therapy

• Treatment stability: Those on antithyroid medications or post-treatment (radioactive iodine or surgery) with stable thyroid hormone levels are generally suitable candidates

• Concurrent medications: Potential interactions with thyroid medications should be considered

• Individual risk-benefit assessment: The clinical need for weight loss must be weighed against any theoretical risks

Patients with uncontrolled hyperthyroidism should not commence Saxenda until their thyroid function is optimised, as the metabolic effects of excess thyroid hormone can complicate weight management and increase cardiovascular risks.

Use should follow NICE TA664 (specialist service; maximum duration 2 years). Avoid in pregnancy and during breastfeeding; limited data in those aged ≥75; do not combine with other GLP-1 RAs or other weight-loss medicines. A thorough discussion with both an endocrinologist and the prescribing clinician is advisable for patients with active or previously treated Graves disease considering Saxenda therapy.

Potential Risks and Thyroid-Related Considerations

While Saxenda can be used in patients with Graves disease, several thyroid-related considerations and general risks warrant attention. Understanding these potential concerns enables informed decision-making and appropriate monitoring strategies.

Thyroid-specific considerations:

Although there is no established link between GLP-1 receptor agonists and Graves disease or hyperthyroidism, patients should be aware of thyroid-related warnings. The theoretical risk of thyroid C-cell tumours, based on rodent studies, led to the warning in the UK SmPC. Patients should report any symptoms suggestive of thyroid masses, such as:

• A lump or swelling in the neck

• Difficulty swallowing or breathing

• Persistent hoarseness

General adverse effects of Saxenda:

The most common side effects are gastrointestinal, affecting up to 40% of patients according to the SmPC, including nausea, vomiting, diarrhoea, and constipation. These typically improve with continued use and gradual dose titration.

Gallbladder disease including cholelithiasis and cholecystitis can occur. Patients should seek medical attention for persistent upper abdominal pain, jaundice, or fever.

Cardiovascular considerations are particularly relevant for patients with Graves disease, as hyperthyroidism itself increases cardiovascular strain. Saxenda can cause a modest increase in heart rate (average 2–3 beats per minute), which requires monitoring in patients with pre-existing cardiac conditions.

Pancreatitis is a rare but serious adverse effect. Patients should discontinue Saxenda and seek immediate medical attention if they experience severe, persistent abdominal pain.

Dehydration and acute kidney injury can occur due to gastrointestinal side effects. Patients should maintain adequate hydration and seek help for reduced urine output.

Hypoglycaemia risk is increased primarily when Saxenda is used alongside sulfonylureas or insulin, though this is less relevant for patients without diabetes.

For patients with Graves disease, the interaction between thyroid status and weight management is complex. Hyperthyroidism typically causes weight loss, whilst treatment often leads to weight gain, potentially creating a clinical indication for weight management therapy. However, metabolic instability during active disease or treatment adjustment periods may complicate the assessment of Saxenda's effectiveness and tolerability.

Monitoring and Safety Guidance for Patients

Patients with Graves disease using Saxenda require comprehensive monitoring to ensure both thyroid stability and medication safety. A coordinated approach between the GP, endocrinologist, and prescribing clinician optimises outcomes and minimises risks.

Thyroid function monitoring:

Regular thyroid function tests are essential for all patients with Graves disease, typically every 6–12 weeks during active treatment or dose adjustments, and every 6–12 months once stable. When initiating Saxenda, consider:

• Baseline thyroid function tests (TSH, free T4, free T3) before starting treatment

• More frequent monitoring (every 4–8 weeks) during the first few months of Saxenda therapy, based on clinical judgement and disease activity

• Continued surveillance for symptoms of thyroid dysfunction

General safety monitoring for Saxenda:

• Heart rate and blood pressure should be monitored regularly, particularly in the first few months

• Weight and BMI tracking to assess treatment response

• Blood glucose monitoring if diabetic or at risk of diabetes

• Renal function assessment, as gastrointestinal side effects can lead to dehydration

• Stop Saxenda if <5% weight loss after 12 weeks on the 3.0 mg dose (per SmPC)

When to contact your GP or seek medical attention:

Patients should be advised to contact their healthcare provider if they experience:

• Symptoms of thyroid dysfunction: palpitations, tremor, heat intolerance, unexplained weight changes, or fatigue

• Severe abdominal pain that doesn't resolve (possible pancreatitis)

• Neck swelling or difficulty swallowing

• Persistent nausea or vomiting leading to dehydration

• Signs of allergic reaction: rash, itching, difficulty breathing

• Mood changes or suicidal thoughts (monitoring is prudent; current evidence has not established causality; seek urgent help if experiencing suicidal thoughts)

Do not use during pregnancy or breastfeeding; inform your clinician if you become pregnant or plan pregnancy.

Suspected side effects should be reported via the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Practical administration advice:

Saxenda should be injected subcutaneously in the abdomen, thigh, or upper arm at any time of day, with or without meals. Injection sites should be rotated to prevent lipodystrophy. Patients should be trained on proper injection technique and pen device use. The medication requires refrigeration before first use but can be stored at room temperature (below 30°C) for up to one month after opening.

Alternative Weight Management Options

For patients with Graves disease who are unsuitable for Saxenda or prefer alternative approaches, several evidence-based weight management options are available through the NHS and private healthcare settings.

Other pharmacological options:

Orlistat (Xenical, Alli) is a lipase inhibitor that reduces fat absorption from the diet by approximately 30%. It is available on NHS prescription for patients meeting BMI criteria and may be suitable for those with thyroid conditions. Common side effects include gastrointestinal symptoms, particularly with high-fat meals. NICE recommends orlistat alongside a low-fat diet and should only be continued beyond three months if at least 5% weight loss is achieved (or ≥3% for people with type 2 diabetes). Fat-soluble vitamin supplements may be needed, taken at least 2 hours before or after orlistat.

Wegovy (semaglutide 2.4 mg) is another GLP-1 receptor agonist, similar to Saxenda but administered weekly rather than daily. The UK SmPC includes similar warnings about thyroid C-cell tumours as Saxenda. NICE TA814 recommends semaglutide within a specialist weight management service, for people meeting specific BMI thresholds (including lower ethnic-specific thresholds where appropriate), and for a maximum 2-year duration. Wegovy has shown superior weight loss efficacy in clinical trials compared to liraglutide.

Non-pharmacological approaches:

Structured lifestyle programmes remain the foundation of weight management. NHS-funded programmes such as the NHS Digital Weight Management Programme provide evidence-based support including:

• Personalised dietary advice and calorie reduction strategies

• Physical activity guidance tailored to individual capabilities

• Behavioural change techniques and psychological support

• Group or individual coaching sessions

Dietitian-led interventions can be particularly valuable for patients with Graves disease, as thyroid dysfunction affects metabolic rate and nutritional requirements. Referral to specialist weight management services may be appropriate for complex cases.

Bariatric surgery represents the most effective long-term weight management intervention for severe obesity. Procedures such as gastric bypass or sleeve gastrectomy may be considered for patients with BMI ≥40 kg/m² or ≥35 kg/m² with significant comorbidities, following NICE guidance. Graves disease is not a contraindication to bariatric surgery, though thyroid function should be optimised pre-operatively.

Ultimately, the choice of weight management strategy should be individualised, considering thyroid status, comorbidities, patient preferences, and available resources. A multidisciplinary approach involving endocrinology, nutrition, and weight management specialists provides the best outcomes for patients with Graves disease seeking to manage their weight safely and effectively.

Frequently Asked Questions