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. 2025 Nov 5;16:2034. doi: 10.1007/s12672-025-03766-8

Global trend and geographic distribution of thyroid cancer from 1990 to 2021 and its prediction until 2030

Zahra Maleki 1,2,✉, Jafar Hassanzadeh 3, Mohammad Aryaie 4, Haleh Ghaem 5,✉
PMCID: PMC12589739  PMID: 41191188

Abstract

Background

This study aimed to determine global thyroid cancer incidence and mortality trends from 1990 to 2021 and their projections for 2030.

Methods

This ecological study extracted data on global thyroid cancer incidence and mortality from 1990 to 2021 from the Global Burden of Disease (GBD) website. Data analysis was performed using Join Point software version 5.0.2 to evaluate trends in incidence and mortality.

Results

The age-standardized incidence rate in all World Health Organization (WHO) regions was higher in women than men. This study showed that the average annual changes in the incidence of thyroid cancer increased from 1990 to 2021. The highest annual increase was observed in men and women in the Eastern Mediterranean region and the lowest in Europe. Average annual changes in mortality rates from 1990 to 2021 showed that mortality rates decreased in Europe and Africa but increased in the Eastern Mediterranean region and Southeast Asia. Projections for 2023 showed that the incidence of thyroid cancer will increase for both men and women in the Eastern Mediterranean. Meanwhile, a decreasing incidence was observed in the European region for women. Projections for 2030 showed that female mortalities would still be higher than male mortalities, except in the Western Pacific region. Also, the highest mortality in women was reported in the Eastern Mediterranean region, and in men, the Southeast Asian region showed an increasing trend.

Conclusion

This study shows an increasing trend in the incidence of thyroid cancer in most regions, especially in the Eastern Mediterranean. It emphasizes that mortality in women is still higher than in men. A decrease in mortality was observed in some regions, such as Europe and Africa, but in Southeast Asia and the Eastern Mediterranean, this has been increasing. These findings highlight regional disparities in the burden of thyroid cancer and suggest that there may be a need to improve cancer surveillance and more equitable access to health services in regions with increasing trends in incidence and mortality.

Keywords: Thyroid cancer, Incidence, Mortality, World

Background

Thyroid cancer is one of the most common endocrine malignancies [1, 2]. This cancer is the ninth most common cancer in both sexes and the fifth most common cancer in women in the world. Studies in Australia and the United States confirmed the increasing trend of thyroid cancer, reporting the increase as exponential [3–5]. The incidence of this cancer has increased by 20% between 1990 and 2013 [6]. Globally, in 2020, the age-standardized incidence rates of thyroid cancer were 10.1 per 100,000 people in women and 3.1 per 100,000 people in men. Age-standardized mortality rates were 0.5 per 100,000 people in women and 0.3 per 100,000 people in men [7]. Thyroid cancer was the second most common cancer among women in Bahrain, Kuwait, Qatar, Saudi Arabia, Oman, and UAE. An average of 550 new cases (9.6% of all cancers in women) are reported each year [8]. More than half of the burden of thyroid cancer is reported in Asia. Considering the incidence rate of this cancer in Asian countries is lower than in the world, America, and Europe, the highest rate of mortality due to thyroid cancer occurs in Asia and it has the highest burden of the disease [9].

In the United States, the incidence of thyroid cancer also increased between 1975 and 2013. Overdiagnosis and increasing detection of small tumors through screenings, thyroid ultrasound, and aspiration biopsies lead to a significant increase in the incidence of thyroid cancer. These small tumors never cause symptoms or require treatment [4, 10]. In countries with a high and very high human development index (HDI), the incidence of cancer in both sexes has been five times higher than in countries with a low or medium HDI. The highest incidence was reported in the Federated States of Micronesia and French Polynesia (18.5 per 100,000 women), North America (18.4 per 100,000), and East Asia (17.8 per 100,000). South Korea has also reported an incidence rate of 45 per 100,000. Mortality rates in most countries for both sexes are reported to be less than one in 100,000. The highest ratio of incidence to mortality in both sexes was reported in South Korea, Cyprus, and Canada, respectively [7]. Although studies confirm the growing trend, i.e., the actual increase in the incidence of thyroid cancer, the mortality rate of this cancer is much lower than the incidence [4, 11, 12]. Changes in these trends are consistent with temporal changes in the prevalence of some risk factors such as obesity and passive smoking [13]. Studies also showed that countries with higher socio-economic indicators reported higher incidence and lower mortality rates [9, 14]. Considering there is no comprehensive study that examines the epidemiological indicators of thyroid cancer in WHO regions, this study aims to determine the trends of the epidemiological indicators of thyroid cancer in the world during the years 1990–2021 and predict them until 2030. It was done using Joinpoint regression.

Method

In this global ecological study, the data on thyroid cancer was obtained from the GBD website (https://www.healthdata.org/). The world included six regions of the World Health Organization (African Region, Region of the Americas, South-East Asian Region, European Region, Eastern Mediterranean Region, and Western Pacific Region). Age-standardized incidence and mortality by sex were used in this study. This information was entered into Excel software, which was also used for preliminary analysis including graphs and maps.

Phase 1: Trend of the epidemiology indices of thyroid cancer

Analyzing the time trends of factors such as incidence rates and mortality is an important component of health planning in any society. Time trend analysis makes it possible to interpret changes over time more accurately. The most significant advantage of the Joinpoint regression model compared to other models is its ability to identify the points in time when significant changes in trends have occurred. One of the main reasons for utilizing the Joinpoint regression model for time trend analysis is its ability to identify the points in time when significant changes in trends have occurred. In summary, it is the detection of the number and location (time) of changes in the trend.

The information was entered into Joinpoint software to examine thyroid cancer incidence and mortality trends. Joinpoint software is one statistical software that performs Joinpoint regression provided by the American Cancer Society (https://surveillance.cancer.gov/joinpoint/). A statistically significant point forms a regression of the Joinpoint on the previous point. It forms segments and makes an Annual Percentage Change (APC) for each segment or piece. The software also provides the Average Annual Percentage Change (AAPC). These two values examine the trends in change from 1990 to 2021. The main indicators resulting from the Joinpoint regression model are Annual Percent Change (APC) and Average Annual Percent Change (AAPC). These indicators represent the increase or decrease in percentage changes each year. If the APC is negative, it indicates a decreasing trend. If positive, indicating an increasing trend. The AAPC represents the average of these changes. This is used to describe linear trends based on each period [15].

Introducing the model and modeling method

The Joinpoint regression model is a method that divides data into subsets, each with its unique linear trend, where the linear segments are separated by “breakpoints”. Thus, for each segment, there is a distinct linear regression function with different parameters. The linear model's regression equation is as follows:

graphic file with name 12672_2025_3766_Article_Equa.gif

One of the most commonly used methods for estimating the parameters of the Joinpoint regression model is the least squares method. To determine the location of breakpoints and estimate parameters using this method, Lerman’s Grid Search techniques were employed. The optimal model (number of breakpoints) is determined using the permutation test with Monte Carlo resampling, which involves comparing models with different numbers of breakpoints [16].

Phase 2: Prediction of trends of the epidemiology indices of thyroid cancer

In this phase, Excel software was used to predict global incidence and mortality trends by sex to 2030, according to the AAPC values and the following two formulas. Based on these formulas, the first was used when the AAPC number was positive and the second was used when negative. 'Id' in these formulas is Epidemiological indices. AAPC is the average annual rate of change obtained from Joinpoint software. 'n' is the number of years for which the prediction was made. 'n' in this formula was 9 years [17, 18].

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Result

Phase 1: Trend of the epidemiology indices of thyroid cancer

Age-standardized incidence rate

In 1990, the incidence of thyroid cancer per 100,000 people in different WHO regions for men and women showed that the incidence was higher in women than in men in each region. Rates vary considerably in the other regions. The highest incidence rate was in European and the lowest in African regions. Women had the highest incidence in Europe, with 4.15 cases per 100,000. The incidence rate for men was relatively lower (2.17 per 100,000) but still the highest among men in all regions. After the European region, American women had the highest incidence, with an incidence rate of 3.33 per 100,000. African women and men had the lowest incidence rates, 1.44 and 0.50 per 100,000, respectively. More details are provided in Fig. 1.

Fig. 1.

Fig. 1

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Age-standardized incidence rate of thyroid cancer in WHO regions in 1990

The incidence of thyroid cancer in 2021 and 2030 is still higher in women than in men. Meanwhile it is the highest in the Eastern Mediterranean region and America and the lowest in Africa. Figures 2 and 3 show the incidence of thyroid cancer in 2021 and 2030. Fitting of age-standardized incidence data for thyroid cancer in men for the WHO regions from 1990 to 2021 using the Joinpoint regression model showed 4 breakpoints for the African regions in 1997, 2001, 2006, and 2021, resulting in five time periods. The age-standardized incidence rate of thyroid cancer in African regions increased by 0.78% each year from 1990 to 1997. The annual increase was 0.17% from 1997 to 2001, 1.42% from 2001 to 2006, and 2.10% from 2006 to 2021.

Fig. 2.

Fig. 2

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Age-standardized incidence rate of thyroid cancer in WHO regions in 2021

Fig. 3.

Fig. 3

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Age-standardized incidence rate of thyroid cancer in WHO regions in 2030

The Eastern Mediterranean region exhibited four breakpoints in 2001, 2011, 2015, and 2021, resulting in five distinct periods. The age-standardized incidence rate of thyroid cancer increased by 2.22% annually from 1990 to 2001, by 4.81% from 2001 to 2011, by 3.46% from 2011 to 2015, and by 1.67% from 2015 to 2021. The European region experienced three breakpoints in 1999, 2009, and 2012, resulting in four distinct periods. The age-standardized incidence rate of thyroid cancer increased by 1.40% annually from 1990 to 1999, and reached an annual growth of 2.97% between 1999 and 2009, but decreased by 4.60% annually from 2009 to 2012, a change that was not statistically significant. The American regions experienced three breakpoints in 2001, 2004, and 2009, resulting in four distinct periods. The age-standardized incidence rate of thyroid cancer increased by 2.53% annually from 1990 to 2001, then decreased by 2.37% annually between 2001 and 2004, and increased by 2.10% annually between 2004 and 2009. The Southeast Asian region experienced three breakpoints in 2004, 2008, and 2020, resulting in four distinct periods. The age-standardized incidence rate of thyroid cancer increased by 2.06% annually from 1990 to 2004, followed by annual growth of 3.31% from 2004 to 2008, and an increase of 2.52% from 2008 to 2020. The Western Pacific region experienced three breakpoints in 2003, 2011, and 2021, leading to the establishment of four distinct periods. The age-standardized incidence rate of thyroid cancer increased by 2.67% annually from 1990 to 2003. From 2003 to 2011, this rate decreased by 6.16% annually, but from 2011 to 2021, it increased again at an annual rate of 1.13% (Fig. 7).

Fig. 7.

Fig. 7

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Age-standardized incidence rate of thyroid cancer in male in WHO region (1990–2030)

Overall, the age-standardized incidence rate of thyroid cancer in men during the study period (1990 to 2021) has shown varying increases across different regions. In Africa, Eastern Mediterranean, Europe, America, Southeast Asia, and the western Pacific Ocean, the average annual increases were 1.45%, 3.10%, 0.59%, 1.17%, 2.41%, and 2.94%, respectively (Table 1).

Table 1.

The global average annual percent of change (AAPC) in thyroid cancer incidence in male (1990–2021)

Cohort Lower endpoint Upper endpoint AAPC Lower CI Upper CI Test statistic ~  P-value ~ 
African Region—4 Joinpoints 1990 2021 1.4583* 1.4153 1.5013 66.9114  < 0.000001
Eastern Mediterranean Region—3 Joinpoints 1990 2021 3.1090* 2.9500 3.2682 38.8829  < 0.000001
European Region—3 Joinpoints 1990 2021 0.5996* 0.0954 1.1065 2.3317 0.019716
Region of the Americas—3 Joinpoints 1990 2021 1.1700* 0.6726 1.6698 4.6261 0.000004
South-East Asia Region—2 Joinpoints 1990 2021 2.4155* 2.3574 2.4737 82.3825  < 0.000001
Western Pacific Region—4 Joinpoints 1990 2021 2.9459* 2.7276 3.1648 26.7974  < 0.000001
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Data analysis of the age-standardized incidence rate of thyroid cancer in women for different regions of the WHO between 1990 and 2021 using the join point regression model, identified three breakpoints in the African region in 1996, 2014, and 2021, divided into four periods. In the African region, the age-standardized incidence rate of thyroid cancer increased by 0.13% annually from 1990 to 1996. This trend accelerated to an annual increase of 0.83% from 1996 to 2014 and 1.86% from 2014 to 2021.

In the Eastern Mediterranean region, three breakpoints were identified in 1994, 1998, and 2013, resulting in the separation of four time periods. The age-standardized incidence rate of thyroid cancer increased by 3.56% annually from 1990 to 1994. From 1994 to 1998, this increasing trend continued, with an annual rate of 1.07%. Then, from 1998 to 2013, the increase rate accelerated again to 3.30% per year. The European region also experienced three breakpoints in 1996, 2001, and 2010, leading to the establishment of four time periods. The age-standardized incidence rate of thyroid cancer increased by 1.95% annually from 1990 to 1996. This amount decreased by 0.96% annually from 1996 to 2001 and reached an annual increase of 2.54% from 2001 to 2010.

The American region also experienced a breakpoint in 2008, leading to the establishment of two time periods. The age-standardized incidence rate of thyroid cancer increased by 1.39% annually from 1990 to 2008. Southeast Asia also experienced two breakpoints in 2001 and 2004, leading to the establishment of three time periods. The age-standardized incidence rate of thyroid cancer increased by 2.21% annually from 1990 to 2001. This rate continued from 2001 to 2004 with an annual growth of 1.08%. The Western Pacific also experienced four breakpoints in 1996, 2002, 2010, and 2016, leading to the establishment of five time periods. The age-standardized incidence rate of thyroid cancer increased by 2.04% annually from 1990 to 1996. From 1996 to 2002, this amount also increased by 0.64% annually, in 2002 to 2010, it increased by 2.77% annually. However, between 2010 and 2016, it decreased by 0.46 percent every year (Fig. 8).

Fig. 8.

Fig. 8

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Age-standardized incidence rate of thyroid cancer in female in WHO region (1990–2030)

Overall, the age-standardized incidence of thyroid cancer in women during the study period (1990 to 2021) in Africa, Eastern Mediterranean, Europe, America, Southeast Asia, and the Western Pacific has shown varying trends. The average annual changes were a 0.92% increase, a 2.46% increase, a 0.0064% decrease, a 0.93% increase, a 1.95% increase, and a 1.35% increase, respectively (Table 2).

Table 2.

The global average annual percent of change (AAPC) in thyroid cancer incidence in female (1990–2021)

Cohort Lower endpoint Upper endpoint AAPC Lower CI Upper CI Test statistic ~  P-value ~ 
African Region—5 joinpoints 1990 2030 0.9228* 0.8577 0.9879 27.8954  < 0.000001
Eastern Mediterranean region—6 Joinpoints 1990 2030 2.4643* 2.3367 2.5921 38.2873  < 0.000001
European Region—4 joinpoints 1990 2021 − 0.0064 − 0.2667 0.2547 -0.0478 0.961891
Region of the Americas—1 joinpoint 1990 2021 0.9336* 0.7964 1.0710 13.3904  < 0.000001
South-East Asia Region—4 joinpoints 1990 2021 1.9561* 1.7549 2.1578 19.2168  < 0.000001
Western Pacific Region—5 joinpoints 1990 2021 1.3525* 1.0987 1.6070 10.5010  < 0.000001
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Age-standardized mortality rate

The highest mortality rate of thyroid cancer per 100,000 people in 1990 was in women in Europe and Southeast Asia (Fig. 4).

Fig. 4.

Fig. 4

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Age-standardized Mortality Rate of thyroid cancer in WHO regions in 1990

Figure 5 compares the mortality rate per 100,000 people in 2021 between women and men in different WHO regions. Women’s mortality rates per region range from 0.44 to 0.77, while men's mortality rates range from 0.38 to 0.50 per 100,000 population. The highest mortality rate for women was found in both the Eastern Mediterranean region and Southeast Asia, at 0.77 per 100,000 people. The lowest mortality rate for men was observed in the African region, at 0.38 per 100,000 people. In the Western Pacific region, the men's mortality rate was 0.50 per 100,000 people, which was slightly higher than the female mortality rate of 0.48 per 100,000 people.

Fig. 5.

Fig. 5

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Age-standardized mortality rate of thyroid cancer in WHO regions in 2021

Figure 6 shows that mortality rates for women range from 0.38 to 0.81 and for men from 0.37 to 0.53 per 100,000 people. The Eastern Mediterranean region will have the highest mortality rate for women. In 2030, the mortality rate of women will be higher than that of men in all regions except the Western Pacific region.

Fig. 6.

Fig. 6

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Age-standardized mortality rate of thyroid cancer in WHO regions in 2030

In the Western Pacific region, the mortality rate for men will be 0.52, which is higher than that for women at 0.44 per 100,000 people. Also, the highest mortality rate among women in the Eastern Mediterranean region with a rate of 0.81 per 100,000 people will be the highest in all regions. Fitting the age-standardized mortality rate data from thyroid cancer in men for the WHO regions during 1990 to 2021 using a joinpoint regression model showed four breakpoints for the African region in 1997, 2002, 2007 and 2019, resulted in five time periods. The age-standardized mortality rate due to thyroid cancer in the African region increased by 0.30% every year from 1990 to 1997. From 1997 to 2002, there was a decrease of 0.58% every year, from 2002 to 2007, there was an increase of 0.49% every year, and from 2007 to 2019, there was an increase of 0.84% ​​every year. The Eastern Mediterranean region also had four breakpoints during 2002, 2008, 2015, and 2021, resulting in five time periods. The age-standardized mortality rate due to thyroid cancer increased by 0.93% every year between 1990 and 2002. This mortality rate increased by 2.10% between 2002 and 2008, 1.00% between 2008 and 2015, and 0.02% between 2015 and 2021. The European region experienced three breakpoints in 1996, 1999, and 2002, leading to the establishment of four time periods. The age-standardized mortality rate of thyroid cancer increased by 0.07% annually from 1990 to 1996. This rate decreased by 3.48% annually between 1996 and 1999, however, increased by 1.42% annually from 1999 to 2002. The American region also had four breakpoints during 1993, 1997, 2000, and 2003, resulting in five time periods. The age-standardized mortality rate of thyroid cancer increased by 1.69% annually from 1990 to 1993. This rate decreased by 0.30% annually between 1993 and 1997 and increased by 1.86% annually from 1997 to 2000. The age-standardized mortality rate decreased by 1.21% every year between 2000 and 2003. The Southeast Asian region also experienced three breakpoints in 1997, 2002, and 2008, leading to the establishment of four time periods. The age-standardized mortality rate of thyroid cancer increased by 1.50% annually from 1990 to 1997. This amount continued from 1997 to 2002 with an annual growth of 0.69% and reached an increase of 1.41% from 2002 to 2008. The Western Pacific region also experienced four breakpoints in 1998, 2004, 2012, and 2020, leading to the establishment of five time periods. The age-standardized mortality rate of thyroid cancer increased by 1.25% annually from 1990 to 1998. From 1998 to 2004, this rate increased by 0.12% annually. From 2004 to 2012, it increased again with an annual rate of 2.47%, while from 2012 to 2020, it decreased by 1.14% (Fig. 9).

Fig. 9.

Fig. 9

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Age-standardized mortality rate of thyroid cancer in male in WHO region (1990–2030)

In general, the age-standardized mortality rate due to thyroid cancer in men during the study (1990 to 2021) in the regions of Africa, Eastern Mediterranean, Europe, America, Southeast Asia, and Western Pacific respectively, on average 0.40% increase, 1.00% increase, 0.95% decrease, 0.38% increase, 1.12% increase and 0.59% increase annually (Table 3).

Table 3.

The global average annual percent of change (AAPC) in thyroid cancer mortality in male (1990–2021)

Cohort Lower endpoint Upper endpoint AAPC Lower CI Upper CI Test statistic ~  P-value
African Region—4 Joinpoints 1990 2021 0.4016* 0.3580 0.4453 18.0547  < 0.000001
Eastern Mediterranean Region—4 Joinpoints 1990 2021 1.0054* 0.9347 1.0761 28.0015  < 0.000001
European Region—3 Joinpoints 1990 2021 − 0.9503* − 1.4548 − 0.4433 − 3.6653 0.000247
Region of the Americas—2 Joinpoints 1990 2021 0.3860* 0.0479 0.7252 2.2383 0.025200
South-East Asia Region—3 Joinpoints 1990 2021 1.1234* 0.9939 1.2530 17.0934  < 0.000001
Western Pacific Region—4 Joinpoints 1990 2021 0.5993* 0.2647 0.9350 3.5155 0.000439
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Data analysis on age-standardized mortality of thyroid cancer in women for different WHO regions from 1990 to 2021 using a join point regression model identified three breakpoints in the African region in 1998, 2012, and 2021, divided into four periods. In the African region, the age-standardized mortality rate of thyroid cancer decreased by 0.23% from 1990 to 1998. This trend decreased by 0.52% from 1998 to 2012 and increased by 0.22% from 2012 to 2021.

In the Eastern Mediterranean region, four breakpoints were identified in 1994, 2006, 2015, and 2021, leading to the separation of five time periods. The age-standardized mortality rate of thyroid cancer increased by 1.73% between 1994 and 2006. From 2006 to 2015, this increasing trend continued, but with an annual rate of 0.93%. Then, from 2015 to 2021, the mortality rate decreased by 0.56%. The European region also experienced four breakpoints in 1995, 1999, 2015, and 2019, leading to the establishment of five time periods. The age-standardized mortality rate of thyroid cancer decreased by 0.47% from 1990 to 1995. From 1995 to 1999, this rate decreased by 2.42% annually, and from 1999 to 2015, it decreased by 1.34%. From 2015 to 2019, the mortality rate decreased by 3.05%. The American region also experienced two breakpoints in 1993 and 1999, leading to the establishment of three time periods. The age-standardized mortality rate of thyroid cancer increased by 1.26% annually from 1990 to 1993. Meanwhile this rate decreased by 0.65% from 1993 to 1999. The Southeast Asia region also experienced four breakpoints in 1996, 2011, 2018, and 2021, leading to the establishment of five time periods. The age-standardized mortality rate of thyroid cancer increased by 0.91% annually from 1990 to 1996. This rate increased by 0.07% from 1996 to 2011. From 2011 to 2018, the mortality rate increased by 0.65%. From 2018 to 2021, the mortality rate decreased by 0.72%. The Western Pacific region also experienced two breakpoints in 1995 and 2014, leading to the establishment of three time periods. The age-standardized mortality rate of thyroid cancer increased by 0.02% from 1990 to 1995. From 1995 to 2014, this rate decreased by 1.42% (Fig. 10).

Fig. 10.

Fig. 10

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Age-standardized mortality rate of thyroid cancer in female in WHO region (1990–2030)

In general, the age-standardized mortality rate due to thyroid cancer in women during the study period (1990 to 2021) across the regions of Africa, the Eastern Mediterranean, Europe, the Americas, Southeast Asia, and the Western Pacific showed the following annual average changes: a 0.24% decrease, a 0.50% increase, a 1.62% decrease, a 0.06% increase, a 0.28% increase, and a 1.01% decrease (Table 4).

Table 4.

The global average annual percent of change (AAPC) in thyroid cancer mortality in female (1990–2021)

Cohort Lower endpoint Upper endpoint AAPC Lower CI Upper CI Test statistic P-value
African Region—4 Joinpoints 1990 2021 − 0.2416* − 0.3638 − 0.1193 − 3.8687 0.000109
Eastern Mediterranean Region—3 Joinpoints 1990 2021 0.5026* 0.4363 0.5689 14.9002  < 0.000001
European Region—3 Joinpoints 1990 2021 − 1.6255* − 1.8225 − 1.4280 − 16.0192  < 0.000001
Region of the Americas—2 Joinpoints 1990 2021 0.0640 − 0.1208 0.2492 0.6785 0.497452
South-East Asia Region—3 Joinpoints 1990 2021 0.2872* 0.1340 0.4408 3.6754 0.000237
Western Pacific Region—2 Joinpoints 1990 2021 − 1.0144* − 1.1404 − 0.8883 − 15.6905  < 0.000001
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Phase 2: Prediction of trends of the epidemiology indices of thyroid cancer

The age-standardized incidence of thyroid cancer in men will increase by 1.47% annually from 2021 to 2030 in the African region. The Eastern Mediterranean region will also increase by 3.07% annually from 2021 to 2030. The European region (2022–2030) will increase by 0.70%, America (2009–2030) by 0.50%, Southeast Asia (2020–2030) by 2.40%, and the Western Pacific (2021–2030) by 2.91%.

Age-standardized incidence rates for women from 2021 to 2030 are projected as follows: Africa will see an increase of 0.92%, the Eastern Mediterranean (2022–2030) will increase by 2.50%, Europe (2021–2030) will experience a decrease of 0.14%, America (2008–2030) will have an increase of 0.39%, Southeast Asia (2004–2030) will see an increase of 1.98%, and the Western Pacific (2016–2030) will increase by 1.31%.

The age-standardized mortality rate for men in the African region is projected to increase by 0.39% annually from 2019 to 2030. In the Eastern Mediterranean region (2021–2030), America (2003–2030), Southeast Asia (2008–2030), and the Western Pacific (2020–2030), the age-standardized mortality rates are expected to increase by 1.01%, 0.40%, 0.98%, and 0.53%, respectively. Meanwhile, the age-standardized mortality rate for men in the European region (2002–2030) is projected to decrease by 1.25% annually.

The age-standardized mortality rate for women in the African region will decrease by 0.25% annually from 2021 to 2030. The age-standardized mortality rates in the Eastern Mediterranean region (2021–2030: APC = 0.50), America (1999–2030: APC = 0.07), and Southeast Asia (2021–2030: APC = 0.29) are expected to show an increasing trend. Meanwhile, the regions of Europe (2019–2030: APC = -1.50) and the Western Pacific (2014–2030: APC = -0.79) will experience a decreasing trend. Forecasts for the age-standardized incidence and mortality rates due to thyroid cancer in the six WHO regions have been made up to 2030 (Figs. 7, 8, 9, 10).

Geographical distribution of epidemiological indices of thyroid cancer

The geographical distribution of thyroid cancer incidence rates in men for 2021 shows areas with moderate to high incidence rates (3.06–3.6 per 100,000 men) highlighted in red. Regions such as Europe and parts of the Americas are marked as having higher rates. Areas with moderate incidence rates (2.52–3.06 per 100,000 men), including the Western Pacific region, are indicated in orange. Regions with lower incidence rates (< 1.98 per 100,000 men) are shown in light yellow, which includes areas like Africa and parts of Southeast Asia. Higher incidence rates are observed in more developed and wealthier regions, such as Europe and parts of the Americas. Meanwhile, lower rates are seen in less developed areas like Africa and Southeast Asia. More details on the geographical distribution of incidence and mortality rates of thyroid cancer from 1990, 2021, and 2030 in the six WHO regions are presented in Figs. 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22.

Fig. 11.

Fig. 11

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Geographical distribution of age-standardized incidence Rate of thyroid cancer in men in WHO region in 1990

Fig. 12.

Fig. 12

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Geographical distribution of age-standardized incidence rate of thyroid cancer in men in WHO region in 2021

Fig. 13.

Fig. 13

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Geographical distribution of age-standardized incidence rate of thyroid cancer in men in WHO region in 2030

Fig. 14.

Fig. 14

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Geographical distribution of age-standardized incidence rate of thyroid cancer in women in WHO region in 1990

Fig. 15.

Fig. 15

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Geographical distribution of Age-standardized Incidence Rate of thyroid cancer in women in WHO region in 2021

Fig. 16.

Fig. 16

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Geographical distribution of age-standardized incidence rate of thyroid cancer in women in WHO region in 2030

Fig. 17.

Fig. 17

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Geographical distribution of age-standardized mortality rate of thyroid cancer in men in WHO region in 1990

Fig. 18.

Fig. 18

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Geographical distribution of age-standardized mortality rate of thyroid cancer in men in WHO region in 2021

Fig. 19.

Fig. 19

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Geographical distribution of age-standardized mortality rate of thyroid cancer in men in WHO region in 2030

Fig. 20.

Fig. 20

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Geographical distribution of age-standardized mortality rate of thyroid cancer in women in WHO region in 1990

Fig. 21.

Fig. 21

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Geographical distribution of age-standardized mortality rate of thyroid cancer in women in WHO region in 2021

Fig. 22.

Fig. 22

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Geographical distribution of age-standardized mortality rate of thyroid cancer in women in WHO region in 2030

Discussion

Phase 1: Trend of epidemiological indices of thyroid cancer

This study was conducted to determine the trends of epidemiological indices of thyroid cancer in the world during 1990–2021 and predict them until 2030 using join point regression. The results showed that the age-standardized incidence rate in all WHO regions was higher in women than in men. In 1990, the highest rate of incidence was in the European region and the lowest rate was in the African region.

A population-based study conducted in 2021 to determine the trend of thyroid cancer in terms of histology in 25 countries showed that the incidence of this cancer is higher in women than in men [19]. Another study showed that the incidence of thyroid cancer in women is higher than in men, and an increasing trend of this cancer has been observed in the European region. These findings are consistent with this study [20]. A study conducted in Africa showed that the incidence of thyroid cancer in this region may have resulted in lower statistics due to the lack of diagnostic facilities and lack of access to health care, as well as the lack of accurate registration and reporting systems [21].

The results show that the highest incidence rates are projected in the Eastern Mediterranean and the Americas in 2021 and 2030, while the lowest incidence rate is expected in the African region. The cancer burden in the Eastern Mediterranean region is increasing due to improvements in socioeconomic indicators and demographic social variables [22]. The studies showed that the incidence of thyroid cancer is higher in countries with a high HDI or Social Demographic Index. This trend is attributed to better access to diagnosis and diagnostic techniques, more accurate reporting and registration systems, and increased life expectancy [14, 23].

This study showed that the changes in incidence rates from 1990 to 2021 have shown an average annual increase. The highest annual growth was observed in women and men in the Eastern Mediterranean region. Meanwhile, the lowest growth was associated with the European region. A study in Qatar found that thyroid cancer is the sixth most common cancer among all nationalities and genders. It is also the second most common malignant cancer among women of all nationalities [24]. Additionally, thyroid cancer in Saudi Arabia has shown an increasing trend from 2000 to 2010 and has been reported as the second most common cancer among young Saudi women [25]. The annual average increase in thyroid cancer incidence in the Eastern Mediterranean region may be related to factors such as rapid lifestyle changes (including unhealthy diets, obesity, and decreased physical activity), population growth, increased life expectancy, advancements in diagnostic methods, and greater access to healthcare services. These factors can lead to more frequent diagnoses [26]. In contrast, European countries, with advanced healthcare systems and effective prevention policies, have the lowest incidence rates [27, 28]. This situation may indicate an epidemiological transition in the Eastern Mediterranean region, where non-communicable diseases are rising, while Europe has already passed through this stage.

The results regarding age-standardized mortality rates indicated that annual changes from 1990 to 2021 showed a decrease in mortality in Europe and Africa, while increases were observed in the Eastern Mediterranean and Southeast Asia regions. A study conducted in 2024 showed that Asia bears more than half of the thyroid cancer burden. Although the incidence of this cancer is lower in Asian countries compared with American and European countries, the highest mortality rates occur in Asia, leading to a greater burden of disease [9]. Thyroid cancer mortality depends on age, gender, and disease stage. However, this cancer has a relatively long survival rate, even though the number of deaths in some regions, particularly Asia, has increased [29].

The reduction in mortality in Europe may be attributed to advancements in treatment techniques and improved access to early diagnosis and treatment. In Europe, better management of chronic diseases and robust healthcare systems have contributed to decreased mortality rates. Meanwhile, in Africa, factors such as the lack of accurate registration and reporting systems may have affected the mortality rates. In contrast, the mortality increase in the Eastern Mediterranean and Southeast Asia may be linked to epidemiological transition and lifestyle changes, including unhealthy diets, decreased physical activity, and the rise of non-communicable diseases [30–32].

Phase 2: Prediction of trends of the epidemiology indices of thyroid cancer

The annual increase in incidence during 2021–2030 was observed in most regions for both men and women in the Eastern Mediterranean. A decreasing trend was noted for women in Europe. A Study showed that thyroid cancer is the second most common cancer in Saudi Arabia [33]. Additionally, the EUROCARE-5 study examined data from 86,690 thyroid cancer patients diagnosed between 2000 and 2007 across 29 European countries. The results of this study showed that the 5-year relative survival rate is 88% for women and 81% for men. The increase in survival rates for this cancer in European countries has contributed to a decline in mortality [34].

A study analyzing the trends in the incidence and mortality of thyroid cancer in 19 European countries found that incidence has been increasing annually in 68% of these countries (13 countries), with rates ranging from 0.2% to 2.5%. However, since 1990, incidence rates in EU15 + countries have stabilized [35]. The trends in incidence and mortality of thyroid cancer are dependent on diagnostic and treatment policies. The decreasing trend in incidence in Europe is likely due to reduced overdiagnosis and the refinement of screening strategies, which have been accompanied by changes in environmental factors (such as reduced exposure to radiation) and lifestyle [36, 37]. This highlights the importance of targeted diagnosis and the prevention of unnecessary interventions.

Predictions for 2030 indicate that women's mortality will continue to be higher than that of men's, except in the Western Pacific region. The higher mortality rate among men in the Western Pacific may be attributed to the fact that, in 2021, the mortality rate for men in this region was also higher. Additionally, the highest female mortality was reported in the Eastern Mediterranean region, while an increasing trend was observed among men in Southeast Asia.

Previous studies also emphasized the rising trend of mortality from this cancer in the Eastern Mediterranean and Southeast Asia regions [9, 38]. Considering that South Asia is a region with a low Social Demographic Index, a significant increase in the incidence of thyroid cancer is expected from 2020 to 2030 [38].

Consistent with this study, a study conducted in 2021 titled "Thyroid Cancer: Global Burden and Trends" revealed that thyroid cancer occurs more frequently in countries with high and very high HDI. The Western Pacific region comprises 25.4% of the global population and accounts for 47.6% of thyroid cancer cases. Predictions for thyroid cancer up to 2040 indicate that the incidence of this cancer will increase by 29.9%, and mortality due to it will rise by 67%. The highest increase in mortality is expected to occur in the African region by 2040. Although the incidence of cancer is higher in countries with high HDI, mortality disproportionately remains higher in countries with low HDI, particularly in Africa. This disparity may be attributed to differences in access to healthcare and environmental factors such as ionizing radiation and iodine deficiency. To improve outcomes, global actions are essential, including strengthening cancer registration, enhancing access to healthcare, and reducing inequalities across different regions [39].

Conclusion

Most thyroid cancers have a favorable prognosis; however, identifying regional differences in incidence and mortality rates can help improve healthcare and reduce these disparities. The results of this study show that the epidemiological trends of thyroid cancer vary significantly across different regions of the world concerning incidence and mortality rates. The incidence of thyroid cancer, particularly among women, is higher than that among men in all regions. This trend is expected to continue until 2030. The Eastern Mediterranean, Europe, and Southeast Asia show the highest rates of increasing incidence, while the African region has the lowest rates. Additionally, mortality from thyroid cancer has shown a decrease or relative stabilization in many regions, although a slight increase has been observed in some regions, particularly in the Eastern Mediterranean.

The increase in incidence and mortality rates in certain regions may be attributed to factors such as improved diagnosis, lifestyle changes, and environmental factors. These differences may be related to factors like ionizing radiation and specific types of thyroid cancer. Issues like inadequate access to healthcare services and late cancer diagnosis also play a significant role. Conversely, the reduction in mortality in some regions reflects advancements in treatment and disease management.

These results highlight the importance of targeted planning that is consistent with regional characteristics for controlling thyroid cancer. Policymakers and health professionals should focus on identifying risk factors, raising public awareness, and developing effective prevention and treatment programs. Additionally, forecasts emphasize the need to strengthen healthcare infrastructures and invest in epidemiological research to address future trends of this disease and enhance global health.

Strengths and weaknesses

The strengths of this study are notable. First, it has a widespread reach. Second, it identifies trends in the incidence and mortality of this type of cancer from 1990 to 2021. Third, it determines the prognosis by 2030. Last, the researchers tried to compare annual changes in thyroid cancer estimates using advanced methods, specifically the join point regression method.

The first limitation of this study is the ecological fallacy and the lack of association between group results and individuals. Second, the primary limitation of GBD data sources is the availability of primary data. Although GBD already integrates a large amount of primary data, the lack of more robust cause-specific mortality data in some remote and poorer areas may affect the accuracy of GBD estimates. Third, the GBD database does not include clinical and pathological details such as histological subtypes, tumor size, TNM staging, or treatment information. This limits our ability to interpret the causes of changes in thyroid cancer trends and restricts more detailed epidemiological insight. Fourth, the rationale behind the joinpoint regression model is so complex that the true implications of parameter estimation cannot be fully explained, and the inherent implications of parameter estimation using this model are often counterintuitive.

Acknowledgements

Not applicable.

Author contributions

Z.M. did extraction, analysis, and storage of data. H.G. developed the ideas, contributed to the data analysis, and critically reviewed the manuscript. J.H. and M.A. contributed to data analysis and critically reviewed the manuscript. All authors of this document have read and approved the final version submitted.

Funding

This article was extracted from Zahra Maleki’s approved Ph.D. thesis This study was funded by the Shiraz University of Medical Sciences (grant number ethics IR.SUMS.SCHEANUT.REC.1401.053).

Data availability

The data supporting the findings of this study are available upon reasonable request from the corresponding author [HGH]. Also, the data is available at https://www.healthdata.org/.

Declarations

Ethics approval and consent to participate

This study received ethical approval from Shiraz University of Medical Sciences (IR.SUMS.SCHEANUT.REC.1401.053). Not Applicable (This study used data from the Global Burden of Disease website).

Consent for publication

Not applicable.

Statement on the use of generative artificial intelligence

This paper was edited using large language models (LLMs), including ChatGPT and Grammarly. However, the accuracy of all information was independently verified by the authors.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Zahra Maleki, Email: maleki5146@gmail.com.

Haleh Ghaem, Email: ghaemh@sums.ac.ir.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data supporting the findings of this study are available upon reasonable request from the corresponding author [HGH]. Also, the data is available at https://www.healthdata.org/.

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