Evaluation and projection of the global burden of thyroid cancer from 1990 to 2035: an analysis based on the Global Burden of Disease Study

Abstract

Background

Thyroid cancer (TC) is one of the most rapidly increasing endocrine malignancies worldwide, yet its long-term epidemiologic trends remain incompletely understood. We aimed to evaluate the global, regional, and national burden of TC from 1990 to 2021 and project its incidence and mortality to 2035 based on data from the Global Burden of Disease (GBD) Study.

Methods

The Global Burden of Disease database was used to collect age-standardized incidence rates (ASIR), age-standardized death rates (ASDR) and disability-adjusted life years (DALYs) for TC. Age-standardized rates (ASRs) were employed as indicators for these measurements. We calculated the estimated annual percent change (EAPC) and measured the mean change in ASRs. Additionally, we assessed TC-attributable risk factors and trends across different regions and age groups worldwide. The Bayesian age-period-cohort model was applied to predict future trends until 2035.

Results

In 2021, the worldwide TC age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and age-standardized DALY rates (ASDALYR) per 100,000 population were 2.91 (95% uncertainty interval (UI), 2.61–3.21), 0.53 (95% UI, 0.47–0.57), and 14.57 (95% UI, 12.78–16.11), respectively. Compared with 1990, the EAPC was 1.25 (95% UI, 1.13–1.37) for ASIR, −0.24 (95% UI, −0.27 to 0.21) for ASDR, and −0.14 (95% UI, −0.17 to 0.11) for ASDALY, respectively. As individuals age, the disease burden of TC increases, and there are significant variations across different regions worldwide. Elevated body mass index is a major risk factor for TC-related deaths and DALYs. From 2022 to 2035, the global ASIR is expected to rise slightly from 3.00 (95% UI, 2.92–3.08) in 2022 to 3.62 (95% UI, 3.26–3.97) in 2035, while ASDR and ASDALYR are anticipated to remain relatively stable with just marginal variations.The global ASIR of TC experienced an upward trend from 1990 to 2021; however, ASDR and ASDALY slightly decreased. Projections from 2022 to 2035 indicate a slight increase in ASIR, with ASDR and ASDALY remaining stable.

Conclusion

The global burden of thyroid cancer remains substantial and is projected to continue increasing through 2035. Public health strategies should be strengthened to address modifiable risk factors, particularly reducing obesity rates and optimize comprehensive cancer control for TC, with targeted approaches to early diagnosis in high-risk populations rather than population-wide screening.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13044-026-00288-5.

Introduction

According to the GLOBOCAN 2020 estimates from the International Agency for Research on Cancer (IARC), the incidence of thyroid cancer (TC) has markedly increased over the past three decades [1]. TC has become one of the most prevalent malignancies of the head and neck region and represents a significant public health challenge for humans. The disease occurs more frequently in females than in males, possibly related to hormonal influences. Moreover, genetic predisposition, environmental exposure, and a specific lifestyle contribute to the overall risk of TC [2]. Although TC can occur at any age, it most commonly affects adults between 30 and 60 years. Consequently, implementing different intervention strategies for distinct age groups is imperative. The prognosis and therapeutic outcomes of TC are generally favorable,with high survival rates, particularly for patients diagnosed at an early stage. This finding also highlights the importance of early detection, timely diagnosis, and prompt treatment.

Several studies have indicated the correlations between TC incidence and radiation exposure, female hormones, obesity, iodine intake, heavy metals, and environmental pollutants [3]. However, most previous investigations have relied on regional data, and comprehensive global analyses of TC burden and risk factors remain limited. Before the release of GBD 2019, numerous studies on TC have been circulated [4]. Furthermore, updating the data version is necessary. Given the ongoing changes in diagnostic technology, treatment patterns, and environmental exposures, reassessment using the updated GBD 2021 dataset is necessary.

Therefore, this study aimed to quantify the global, regional, and national burden of thyroid cancer from 1990 to 2021 and to project future trends up to 2035. We further evaluated the contribution of major risk factors to TC-related mortality and disability-adjusted life years (DALYs), providing evidence to inform targeted prevention and public health strategies.

Materials and methods

Data acquisition and download

The GBD 2021 dataset (https://ghdx.healthdata.org/gbd) comprehensively evaluated the adverse health consequences of 371 diseases, injuries and 88 risk factors. This assessment encompassed 204 countries and regions, utilizing the most recent epidemiological information and improved standardized techniques [5, 6]. We utilized the GBD 2021 data to derive determinations and 95% uncertainty intervals (UI) for the ASIR, ASDR, and DALYs of TC, along with corresponding age-standardized rates (ASRs).

Sociodemographic index (SDI)

The SDI serves as a comprehensive indicator reflecting the level of development within a country or region and is calculated based on empirical data encompassing fertility rates, educational attainment, and per capita income [7, 8]. The SDI ranges from 0 to 1, with higher values indicating greater socioeconomic development. The SDI has been reported to correlate with disease incidence and mortality rates. This study categorized geographical regions into five SDI tiers (low, low-medium, medium-high, and high) to investigate the association between cancer burden and socioeconomic progress.

Bayesian age-period-cohort (BAPC) model prediction

We used a BAPC model to predict global burden trends across regions and age groups from 2022 to 2035 [9, 10]. BAPC employed integrated nested Laplace approximations to estimate the marginal posterior distributions, thereby circumventing the mixing and convergence issues inherent in traditional Bayesian techniques employing Markov chain Monte Carlo methods [10]. This approach has been extensively utilized to examine chronic disease trends and forecast future disease burdens [9, 11].

Statistical analysis

The TC burden was described using indicators, which included incidence, deaths, DALYs, and their corresponding ASRs. Each rate is reported at 1 per 100,000 individuals, accompanied by a 95% UI determined by the GBD algorithm [6, 12]. To assess temporal trends, the estimated annual percentage change (EAPC) of ASR was calculated, including age-standardized prevalence rates (ASPR), age-standardized incidence rates (ASIR), mortality rates (ASDR), and DALY rates (ASDALYR) per 100,000 population. The formula y = α + βx + ε was used (where y = ln [ASR], and ×= calendar year). The formula for calculating the EAPC value is EAPC = 100 × (exp(β) − 1). Positive EAPC values with 95% confidence intervals (CIs) exceeding zero showed upward trends, whilst negative values denoted declines. All computations were performed using R Studio (version 4.3.1) from the R Project for Statistical Computing. p values were evaluated on both sides, and p < 0.05 was considered statistically significant.

Results

Global burden

The global incidence of TC reached 249,538.02 (95% UI, 223,290.35– 274,638.17) cases in 2021, compared with 89,885.45 (95% UI, 84,681.27– 96,998.78) cases in 1990. From 1990 to 2021, the global incidence of TC increased by 177.62 (95% UI, 163.68–183.14). The number of cases in females was 167,236.60 (95% UI, 147,083.12– 195,646.63), and the number of cases in males was 82,301.42 (95% UI, 71,574.61– 91,093.02). The female population exhibited a significantly higher incidence than the male population (Fig. 1 and Table 1). The corresponding global ASIR rose from 2.06 (95% UI, 1.95–2.22) in 1990 to 2.91 (95% UI, 2.61–3.21) in 2021, with an EAPC of 1.25 (95% CI, 1.13–1.37; Fig. 1A–B, and Tables 1-2).

Fig. 1.

Worldwide temporal trends of TC, 1990–2021. (A) incident instances; (B) ASIR; (C) death instances; (D) ASDR; (E) DALY cases; (F) ASDALYR

Table 1.

Incident, death, DALY cases during 1990–2021, and percentage change for thyroid cancer from 1990 to 2021 globally and regionally. Abbreviations: UI, uncertainty interval

	Incident cases (95% UI)			Death cases (95% UI)			DALY cases (95% UI)
Location	1990	2021	Percentage change in cases, 1990–2021%)	1990	2021	Percentage change in cases, 1990–2021%)	1990	2021	Percentage change in cases, 1990–2021%)
Global	89885.45(84681.27–96998.78)	249538.02(223290.35-274638.17)	(177.62153.48–203.80)	21893.04(20437.48–24108.12)	44798.54(39924.73–48541.00)	104.62(85.57–121.07)	646740.52(599118.85-717357.00)	1246484.78(1094415.64-1375852.53)	92.73(72.21–112.45)
SDI Regions
High SDI	36533.23(35292.04–37708.31)	72995.75(68514.05–76746.90)	99.81(89.76–109.19)	6504.94(6098.30–6798.37)	9730.15(8465.51–10437.25)	49.58(38.25–57.47)	164381.54(155870.65-173717.89)	220135.91(201450.21-237834.77)	33.92(27.15–40.58)
High-middle SDI	24410.63(22753.35–25919.82)	55158.13(49518.35–62489.01)	125.96(102.04–157.55)	5609.39(5200.92–5934.86)	8436.74(7553.49–9304.46)	50.40(37.33–65.33)	158942.14(146716.94-170152.88)	218961.27(196634.69-244418.11)	37.76(24.76–53.33)
Low SDI	3431.33(2759.40–4295.62)	12358.43(9598.66–16514.53)	260.16(186.64–382.01)	1454.50(1199.18–1778.34)	3392.39(2687.87–4328.67)	133.23(86.63–195.41)	52661.54(43472.14–63947.68)	120143.33(93672.76-157131.37)	128.14(78.42–201.21)
Low-middle SDI	8233.89(7035.03–10302.36)	33464.00(27896.35–40292.70)	306.42(233.29–397.85)	3015.48(2624.04–3757.09)	8531.16(7410.50–9771.61)	182.91(135.55–227.36)	103647.84(90342.84-129887.35)	269914.25(229089.09-316826.25)	160.41(113.55–210.38)
Middle SDI	17155.22(15282.58–19997.29)	75356.85(62755.97–84674.75)	339.26(273.46–402.30)	5275.56(4815.13–6144.76)	14666.55(12466.78–16170.92)	178.01(138.40–213.17)	166176.97(149966.27-190691.45)	416217.61(350751.02-460888.74)	150.47(114.49–182.44)
Geographic Regions
Andean Latin America	422.22(354.04–495.41)	2424.04(1907.19–3044.29)	474.12(343.93–654.48)	182.29(153.41–211.50)	641.15(507.95–794.49)	251.73(179.58–343.87)	5273.77(4419.12–6186.46)	16689.75(13207.67–20766.86)	216.47(151.01–303.70)
Australasia	585.91(522.39–660.14)	1949.08(1569.68–2343.24)	232.66(162.80–312.98)	97.55(87.19–109.14)	199.09(161.28–237.39)	104.09(65.96–152.26)	2544.04(2273.05–2867.78)	5041.08(4103.84–6033.29)	98.15(61.34–141.49)
Caribbean	442.81(410.82–479.30)	1244.90(1085.75–1427.42)	181.13(140.70–224.31)	142.54(131.67–156.04)	321.28(280.67–367.54)	125.40(97.11–156.99)	4116.63(3769.02–4556.27)	8690.20(7532.91–10099.50)	111.10(82.73–143.44)
Central Asia	914.02(840.77–996.13)	1630.91(1432.19–1845.29)	78.43(52.45–106.87)	253.30(235.53–274.31)	339.31(301.74–378.53)	33.96(17.74–53.19)	8144.50(7568.04–8817.06)	10272.95(9055.51–11543.47)	26.13(9.60–45.45)
Central Europe	4654.95(4428.65–4883.57)	4876.20(4406.62–5323.50)	4.75(−5.39–15.33)	1266.35(1213.18–1316.55)	985.67(897.97–1064.61)	−22.16(−28.64–15.59)	34786.28(33224.20–36474.35)	23433.69(21250.35–25475.13)	−32.64(−38.35–26.52)
Central Latin America	1712.24(1651.22–1775.44)	7752.64(6907.36–8701.38)	352.78(298.85–406.62)	635.60(613.94–657.58)	1964.55(1748.82–2165.40)	209.09(176.45–242.42)	18293.11(17666.05–18920.93)	52186.94(47013.26–58083.35)	185.28(154.00–216.89)
Central Sub-Saharan Africa	153.69(111.53–225.91)	495.74(319.21–770.67)	222.57(134.03–337.67)	78.36(57.72–112.85)	182.81(118.40–283.95)	133.30(69.63–213.30)	2545.33(1889.27–3609.51)	5956.33(3862.94–9187.80)	134.01(69.81–218.74)
East Asia	13203.42(10809.46–15460.75)	50885.18(41562.02–63161.88)	285.39(201.59–411.96)	3780.86(3211.55–4380.10)	8063.77(6456.31–9800.11)	113.28(70.76–171.17)	116582.21(98062.29-136720.85)	213609.16(173066.21-262361.67)	83.23(45.86–136.32)
Eastern Europe	6467.78(6164.24–6831.00)	9617.01(8698.10–10650.29)	48.69(32.89–65.24)	1349.47(1274.00–1423.47)	1650.51(1508.20–1807.39)	22.31(9.93–34.68)	37929.98(35923.30–40329.41)	42085.64(38218.33–46388.18)	10.96(−0.45–22.18)
Eastern Sub-Saharan Africa	1908.37(1516.58–2387.79)	6384.36(4629.91–9478.74)	234.55(143.35–396.27)	838.68(685.65–1015.08)	1800.87(1337.63–2485.51)	114.73(61.40–192.20)	31045.98(25044.46–38047.32)	66490.91(48520.21–94804.40)	114.17(58.08–204.56)
High-income Asia Pacific	6950.05(6496.28–7654.35)	14277.63(12630.29–16476.52)	105.43(84.50–131.07)	1235.93(1126.09–1404.50)	2843.94(2308.88–3185.80)	130.10(96.64–154.05)	30855.87(28505.44–35131.27)	50783.19(43704.31–57571.42)	64.58(45.95–80.19)
High-income North America	12130.27(11695.20–12449.97)	28289.12(26782.72–29536.01)	133.21(123.46–144.07)	1391.77(1284.95–1450.11)	2765.74(2473.05–2948.94)	98.72(90.02–107.32)	37316.05(34968.11–39721.43)	70641.63(65003.73–76456.64)	89.31(81.79–97.01)
North Africa and Middle East	3792.01(3150.58–5143.06)	21222.43(17601.95–24974.57)	459.66(321.54–608.43)	657.89(546.12–936.53)	1935.18(1676.06–2236.36)	194.15(121.12–264.72)	21944.43(18189.39–30745.70)	65316.18(55454.15–76496.29)	197.64(121.18–272.43)
Oceania	44.62(29.91–60.25)	131.14(80.16–185.43)	193.91(133.94–262.45)	14.59(10.28–19.25)	36.64(23.31–50.38)	151.13(103.17–210.73)	480.34(324.85–641.47)	1173.57(724.87–1641.55)	144.32(98.51–200.19)
South Asia	7853.09(6476.20–10284.50)	37335.55(30262.71–44931.40)	375.43(264.68–495.93)	2914.53(2454.13–3700.36)	9323.78(7794.25–10741.50)	219.91(152.72–283.27)	105302.87(88400.41-135793.39)	302256.84(249827.83-356789.43)	187.04(123.92–254.21)
Southeast Asia	6440.64(5205.82–7276.51)	26558.99(20898.85–31183.51)	312.37(248.85–377.02)	2008.12(1698.14–2303.11)	5642.89(4564.63–6450.69)	181.00(143.17–221.22)	62694.76(51465.33–70374.51)	164547.42(130332.70-189174.38)	162.46(126.99–200.29)
Southern Latin America	1000.09(896.44–1118.89)	2046.90(1787.24–2334.01)	104.67(79.50–138.60)	358.97(324.67–394.60)	485.25(425.83–553.67)	35.18(16.95–55.79)	9491.85(8618.33–10469.56)	11959.83(10465.34–13594.31)	26.00(9.69–46.24)
Southern Sub-Saharan Africa	376.90(317.82–447.91)	1116.78(934.82–1315.94)	196.31(146.19–256.42)	123.56(102.40–148.33)	323.76(264.47–372.45)	162.02(112.10–214.68)	4035.34(3398.79–4776.44)	10253.24(8481.01–11926.01)	154.09(108.45–207.47)
Tropical Latin America	1371.57(1299.43–1443.40)	4491.06(4197.67–4757.94)	227.44(204.65–249.16)	508.97(480.00–537.21)	1252.79(1142.02–1332.00)	146.14(127.93–161.51)	15021.06(14258.97–15822.75)	32680.45(30547.00–34741.45)	117.56(103.21–132.11)
Western Europe	19206.48(18291.73–20159.23)	26004.52(23787.57–28201.49)	35.39(22.99–47.74)	3951.00(3667.41–4173.81)	3829.19(3318.92–4190.76)	−3.08(−10.88–5.18)	94707.46(89027.17-100543.11)	84464.53(75823.07–92550.47)	-10.82(−17.64–3.48)
Western Sub-Saharan Africa	254.35(186.16–312.39)	803.83(597.74–1068.95)	216.04(144.62–302.26)	102.70(77.78–122.81)	210.36(165.29–263.63)	104.83(62.37–159.11)	3628.66(2761.58–4379.39)	7951.25(6109.34–10288.97)	119.12(72.55–179.25)

Table 2.

Age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), age-standardized disability-adjusted life-year (ASDALY) per 100,000 population in 1990–2021, and estimated annual percentage change (EAPC) for thyroid cancer from 1990 to 2021 globally and regionally. Abbreviations: UI, uncertainty interval

	ASIR			ASDR			ASDLAY
location	1990(95% UI)	2021(95% UI)	EPAC (95% CI), 1990–2021	1990(95% UI)	2021(95% UI)	EPAC (95% CI), 1990–2021	1990(95% UI)	2021(95% UI)	EPAC (95% CI), 1990–2021
Global	2.06(1.95–2.22)	2.91(2.61–3.21)	1.25(1.13–1.37)	0.57(0.53–0.63)	0.53(0.47–0.57)	−0.24(−0.27–0.21)	15.21(14.18–16.83)	14.57(12.78–16.11)	−0.14(−0.17–0.11)
High SDI	3.55(3.43–3.66)	4.49(4.25–4.75)	1.01(0.74–1.29)	0.59(0.55–0.61)	0.44(0.39–0.47)	−0.91(−0.96–0.85)	15.38(14.59–16.28)	11.76(10.79–12.77)	−0.77(−0.86–0.67)
Low SDI	1.13(0.91–1.42)	1.69(1.33–2.20)	1.23(1.11–1.34)	0.60(0.49–0.74)	0.64(0.52–0.80)	0.19(0.11–0.28)	17.75(14.57–21.62)	17.98(14.18–23.06)	−0.05(−0.12–0.02)
High-middle SDI	2.35(2.19–2.49)	3.07(2.75–3.49)	1.05(0.88–1.22)	0.59(0.54–0.62)	0.43(0.39–0.48)	−1.03(−1.09–0.97)	15.57(14.40–16.65)	11.63(10.44–13.02)	−0.99(−1.06–0.92)
Middle SDI	1.35(1.21–1.60)	2.71(2.26–3.05)	2.37(2.28–2.47)	0.53(0.49–0.63)	0.57(0.48–0.63)	0.21(0.15–0.27)	14.02(12.76–16.18)	15.22(12.81–16.81)	0.28(0.22–0.34)
Low-middle SDI	1.05(0.91–1.31)	1.96(1.65–2.34)	2.09(2.07–2.12)	0.48(0.42–0.60)	0.60(0.52–0.68)	0.74(0.70–0.78)	13.75(11.99–17.15)	16.75(14.35–19.42)	0.67(0.63–0.70)
Geographic Regions
Andean Latin America	1.76(1.47–2.05)	3.87(3.05–4.85)	2.60(2.43–2.78)	0.90(0.76–1.04)	1.10(0.87–1.36)	0.66(0.54–0.78)	23.02(19.33–26.97)	27.53(21.72–34.25)	0.54(0.43–0.66)
Australasia	2.61(2.32–2.94)	4.57(3.70–5.54)	2.61(2.04–3.19)	0.42(0.37–0.47)	0.36(0.30–0.43)	0.14(−0.14–0.42)	11.05(9.87–12.46)	10.61(8.67–12.78)	0.51(0.19–0.83)
Caribbean	1.56(1.45–1.69)	2.36(2.06–2.70)	1.50(1.31–1.69)	0.55(0.51–0.60)	0.60(0.52–0.68)	0.42(0.19–0.66)	14.92(13.67–16.46)	16.34(14.15–18.98)	0.46(0.24–0.69)
Central Asia	1.73(1.60–1.89)	1.75(1.54–1.97)	0.01(−0.76–0.78)	0.53(0.50–0.58)	0.43(0.38–0.48)	−0.81(−1.45–0.16)	15.87(14.74–17.22)	11.66(10.33–13.03)	−1.19(−1.84–0.55)
Central Europe	3.20(3.04–3.36)	2.71(2.44–2.95)	−0.65(−0.86–0.44)	0.86(0.83–0.90)	0.44(0.40–0.48)	−2.37(−2.66–2.09)	23.49(22.42–24.62)	11.60(10.50–12.65)	−2.47(−2.77–2.16)
Central Latin America	1.71(1.65–1.78)	2.96(2.64–3.32)	1.66(1.52–1.81)	0.79(0.75–0.81)	0.80(0.71–0.88)	−0.07(−0.26–0.11)	19.54(18.87–20.23)	20.39(18.36–22.67)	0.00(−0.21–0.21)
Central Sub-Saharan Africa	0.57(0.41–0.82)	0.69(0.45–1.09)	0.63(0.41–0.84)	0.36(0.27–0.52)	0.35(0.23–0.56)	−0.11(−0.23–0.01)	9.44(6.94–13.66)	8.92(5.75–13.93)	−0.19(−0.31–0.06)
East Asia	1.30(1.07–1.52)	2.53(2.07–3.14)	2.43(2.25–2.61)	0.48(0.41–0.55)	0.39(0.31–0.47)	−0.65(−0.74–0.55)	12.25(10.38–14.20)	10.25(8.34–12.52)	−0.56(−0.67–0.45)
Eastern Europe	2.43(2.31–2.56)	3.20(2.90–3.55)	1.27(0.78–1.77)	0.50(0.47–0.52)	0.47(0.43–0.52)	−0.25(−0.62–0.11)	13.86(13.11–14.73)	12.87(11.66–14.15)	−0.29(−0.70–0.13)
Eastern Sub-Saharan Africa	1.81(1.46–2.24)	2.41(1.77–3.45)	0.76(0.59–0.93)	1.01(0.82–1.21)	0.99(0.74–1.32)	−0.18(−0.29–0.07)	30.05(24.54–36.69)	27.76(20.55–38.36)	−0.43(−0.56–0.31)
High-income Asia Pacific	3.42(3.19–3.77)	4.40(3.94–5.15)	1.15(0.66–1.63)	0.64(0.58–0.73)	0.50(0.43–0.56)	−0.82(−0.99–0.64)	15.36(14.15–17.48)	11.81(10.45–13.68)	−0.75(−1.00–0.49)
High-income North America	3.81(3.68–3.91)	5.30(5.07–5.53)	1.15(0.97–1.34)	0.39(0.36–0.41)	0.41(0.37–0.44)	0.15(0.06–0.23)	11.23(10.51–11.97)	11.96(11.04–13.03)	0.21(0.10–0.31)
North Africa and Middle East	1.69(1.41–2.30)	3.65(3.05–4.27)	2.89(2.71–3.06)	0.40(0.33–0.58)	0.45(0.39–0.52)	0.64(0.49–0.80)	10.99(9.07–15.49)	12.68(10.87–14.80)	0.76(0.61–0.90)
Oceania	1.19(0.83–1.59)	1.36(0.85–1.87)	0.33(0.24–0.43)	0.56(0.41–0.73)	0.54(0.35–0.73)	−0.13(−0.16–0.10)	13.90(9.85–18.46)	13.55(8.61–18.63)	−0.10(−0.14–0.05)
South Asia	1.01(0.84–1.32)	2.14(1.74–2.56)	2.54(2.46–2.62)	0.48(0.41–0.61)	0.63(0.53–0.73)	0.92(0.88–0.97)	14.21(11.98–18.18)	18.22(15.09–21.35)	0.85(0.81–0.88)
Southeast Asia	2.02(1.68–2.32)	3.61(2.86–4.24)	1.82(1.73–1.90)	0.81(0.69–0.96)	0.90(0.74–1.02)	0.32(0.24–0.40)	21.41(17.91–24.29)	23.60(18.80–27.01)	0.27(0.20–0.35)
Southern Latin America	2.13(1.91–2.38)	2.54(2.22–2.90)	0.70(0.47–0.92)	0.79(0.71–0.86)	0.55(0.48–0.63)	−1.01(−1.27–0.76)	20.25(18.38–22.34)	14.26(12.48–16.21)	−1.02(−1.30–0.74)
Southern Sub-Saharan Africa	1.09(0.91–1.30)	1.61(1.34–1.88)	1.54(1.29–1.80)	0.45(0.37–0.55)	0.57(0.46–0.65)	0.92(0.64–1.19)	12.40(10.31–14.79)	15.67(12.84–18.14)	1.00(0.71–1.29)
Tropical Latin America	1.28(1.22–1.35)	1.73(1.61–1.83)	0.76(0.60–0.92)	0.58(0.54–0.61)	0.50(0.45–0.53)	−0.60(−0.70–0.50)	14.78(14.02–15.58)	12.68(11.83–13.49)	−0.65(−0.76–0.55)
Western Europe	3.88(3.69–4.08)	3.84(3.51–4.18)	0.28(−0.11–0.68)	0.68(0.63–0.71)	0.39(0.34–0.42)	−1.70(−1.77–1.64)	17.60(16.60–18.76)	10.46(9.44–11.54)	−1.50(−1.65–1.35)
Western Sub-Saharan Africa	0.22(0.16–0.26)	0.26(0.20–0.34)	0.52(0.45–0.58)	0.11(0.08–0.13)	0.10(0.08–0.12)	−0.51(−0.59–0.43)	3.18(2.41–3.82)	2.82(2.21–3.55)	−0.49(−0.57–0.42)

The global number of TC-associated deaths was 21,893.04 (95% UI, 20,437.48– 24,108.12) in 1990 versus 44,798.54 (95% UI, 39,924.73– 48,541.00) in 2021. The number of TC-associated deaths in females was 167,236.60 (95% UI, 147,083.12– 195,646.63) in 1990, and the number of TC-associated deaths in males was 82,301.42 (95% UI, 71,574.61– 91,093.02) in 2021. The number of deaths in females with TC was higher than that in males. However, the TC-associated ASDR decreased from 0.57 (95% UI, 0.53–0.63) in 1990 to 0.53 (95% UI, 0.47–0.57) in 2021; the EAPC was −0.24 (95% CI, −0.27 to 0.21; Fig. 1C–D and 2).

The global number of TC-associated DALYs also increased by 77.48% (95% UI, 50.91–97.14). The number in 1990 was 646,740.52 (95% UI, 599,118.85– 717,357.00) versus 1,246,484.78 (95% UI, 1,094,415.64– 1,375,852.53) in 2021. However, the ASDALYR decreased from 15.21 (95% UI, 14.18–16.83) in 1990 to 14.57 (95% UI, 12.78–16.11) in 2021. The EAPC was ˗0.14 (95% CI, −0.17 to 0.11; Fig. 1E and 2).

SDI-related regional burden

The middle SDI area recorded the highest number of TC cases among the five SDI regions in 2021. The figure stood at 75,356.85 (95% UI, 62,755.97– 84,674.75), while the low SDI area recorded the lowest number of TC (12,358.43; 95% UI, 9598.66– 16,514.53). The region with a high SDI exhibited the greatest ASIR of TC at 4.49 (95% UI, 4.25–4.75), whereas the low SDI region recorded the lowest ASIR of TC at 1.69 (95% UI, 1.33–2.20) in 2021. Between 1990 and 2021, the ASIR of TC exhibited the largest increase in the middle SDI region (EAPC = 2.37; 95% CI, 2.28–2.47) and the largest decrease in the high SDI region (EAPC = 1.01; 95% CI, 0.74–1.29; Fig. 2A and Tables 1-2).

Fig. 2.

Temporal patterns in five SDI regions for TC, 1990–2021. (A) incident incidents; (B) ASIR; (C) death instances; (D) ASDR; (E) DALY incidents; (F) ASDALYR

Moreover, the middle SDI region exhibited the highest number of TC fatalities in 2021 (14666.55; 95% UI, 12,466.78– 16,170.92), while the low SDI region had the lowest count (3392.39; 95% UI, 2687.87–4328.67). The ASDR of TC was the highest in the low SDI region (0.64; 95% UI, 0.52–0.80). Conversely, the ASDR of TC was the lowest in the high-middle SDI region (0.43; 95% UI, 0.39–0.48) in 2021. Between 1990 and 2021, the largest ASDR increase in TC was observed in the low-middle SDI region (EAPC = 0.74; 95% CI, 0.70–0.78)), whereas the largest decrease was observed in the high-middle SDI region (EAPC = −1.03; 95% CI, −1.09 to 0.97; Fig. 2C and Tables 1-2).

Furthermore, the middle SDI region reported the highest number of DALY cases with TC in 2021, totaling 416,217.61(95% UI, 350,751.02– 460,888.74), whereas the low SDI region exhibited the lowest count, 120,143.33; 95% UI, 93,672.76– 157,131.37). The low-middle SDI region recorded the highest ASDALYR of TC at 160.41 (95% UI, 113.55–210.38). Conversely, the high-middle SDI region manifested the lowest at 33.92 (95% UI, 27.15–40.58). From 1990 to 2021, the low-middle SDI region experienced the most significant escalation in the ASDALYR of TC (EAPC = 0.67; 95% CI, 0.63–0.70), whereas the high-middle SDI region experienced the most substantial decline (EAPC = −0.99; 95% CI, −1.06 to 0.92; Fig. 2E and 2).

Geographic regional burden

Among 21geographic regions, East Asia experienced the most incident cases of TC in 2021, with a total of 50,885.18 (95% UI, 41,562.02– 63,161.88), whereas Oceania had the fewest incident cases of TC, with a total of 131.14 (95% UI, 80.16–185.43). In 2021, affluent regions of high-income North America experienced the highest age-standardized incidence rate of TC at 5.3 (95% UI, 5.07–5.53), whereas Western Sub-Saharan Africa had the lowest rate of 0.26 (95% UI, 0.20–0.34) in 2021. From 1990 to 2021, the ASIR of TC exhibited the largest increase in Andean Latin America (EAPC = 474.12; 95% CI, 343.93–654.48) and the smallest increase in Central Europe (EAPC = 4.75; 95% CI, −5.39 to 15.33; Figs. 3A and 3B, Supplement Figs. 2A and 3A, and Tables 1-2).

Fig. 3.

Instances and age-standardized rates of TC incidence, death, and DALY worldwide and 21 geographic regions for 1990 and 2021. (A) incident instances; (B) ASIR; (C) death instances; (D) ASDR; (E) DALY cases; (F) ASDALYR

Moreover, Western Europe experienced the most deaths from TC in 2021, with a total of 3829.19 (95% UI, 3318.92–4190.76), whereas Oceania had the fewest, with a total of 736.64 (95% UI, 23.31–50.38). The ASDR of TC was highest in Andean Latin America, with a rate of 1.10 (95% UI, 0.87–1.36). Conversely, the ASDR of TC was lowest in Western Sub-Saharan Africa, with a rate of 1.97 (95% UI, 1.23–2.64) in 2021. From 1990 to 2021, the largest ASDR increase in TC was observed in South Asia (EAPC = 0.92; 95% CI, 0.88–0.97), whereas the largest decrease was observed in Central Europe (EAPC = −2.37; 95% UI, −2.66 to 2.09; Figs. 3C and 3D, Supplement Figs. 5A–C.

In 2021, South Asia exhibited the most DALY cases of TC (302,256.84; 95% UI, 249,827.83– 356,789.43), whereas Oceania exhibited the fewest (1,173.57; 95% UI, 724.87–1641.55). Andean Latin America recorded the highest ASDALYR of TC (216.47; 95% UI, 151.01–303.70), while Central Europe recorded the lowest (˗32.64; 95% UI, −38.35 to 26.52). Between 1990 and 2021, Southern Sub-Saharan Africa experienced the most significant rise in the ASDALYR of TC (1.00; 95% UI, 0.71–1.29), whereas Central Europe saw the greatest decline (EAPC = −2.47; 95% CI, −2.77 to 2.16; Fig. 3E and F, Supplement Figs. 2C and 3C and Tables 1-2).

Different countries and territories burden

In 2021, out of 204 nations and territories, China reported the highest number of incident cases, totaling 48,104.56 (95% UI, 38,694.78–60068.11), and the highest number of fatalities, amounting to 7692.21 (95% UI, 6122.52–9428.76). India recorded the most DALY cases, totaling 225,287.80 (95% UI, 186,616.85– 264,478.46). Simultaneously, Tokelau reported the fewest incident cases at 0.03 (95% UI, 0.02–0.04), fatalities at 0.01 (95% UI, 0.01–0.01), and DALY cases at 0.22 (95% UI, 0.15–0.29) (Fig. 4A and Supplement Tables S1-2).

Fig. 4.

TC incidents, deaths, and DALY cases in 204 countries and territories. (A) Incidents; (B) deaths; (C) DALY cases

Moreover, Saudi Arabia experienced the highest ASIR at 7.13 (95% UI, 5.39–9.33), Ethiopia had the highest ASDR, which was 1.60 (95% UI, 1.10–2.36), and ASDALYR was 44.18 (95% UI, 29.77–67.38) in 2021. Tajikistan exhibited the lowest ASIR, 0.01 (95% UI, 0.01–0.02), ASDR, 0.00 (95% UI, 0.00–0.01), and ASDALYR, 0.12 (95% UI, 0.09–0.17; Fig. 5A–C and Supplement Table S2).

Fig. 5.

Age-standardized rates of TC incidence, death, and DALY per 100,000 population in 204 countries and territories. (A) ASIR; (B) ASDR; (C) ASDALYR

From 1990 to 2021, the Republic of Cabo Verde exhibited the most substantial escalation in terms of ASIR (EAPC = 5.65; 95% CI, 4.73–6.58), ASDR (EAPC = 3.86; 95% CI, 3.28–4.43), and ASDALYR (EAPC = 4.40; 95% CI, 3.59–5.21). However, Poland underwent the most significant decline with a reduction in ASIR (EAPC = −1.59; 95% CI, −2.06 to 1.11), ASDR (EAPC = −3.27; 95% CI, −3.83 to 2.71), and ASDALYR (EAPC = −3.52; 95% CI, −4.11 to 2.92; Supplement Fig. 5A–C and Supplement Table S2).

Age burden and trend changes

In 2021, the number of cases increased with age, with the highest incidence being in the 55–59 years age group, specifically 31,041.73 (95% UI, 27,025.54– 35,710.36). The incidence in females in the 55–59 years age group was the highest, at 19,600.77 (95% UI, 17,266.17– 22,578.22), and the incidence in males in the 55–59 years age group was the highest, 11,440.96 (95% UI, 9759.37– 13,132.14). The incidence rate in females in the 70–74 years age group was the highest, at 10.87 (95% UI, 9.52–12.37). The incidence rate in males in the 85–89 years age group was the highest, 8.27 (95% UI, 7.02–9.12; Fig. 6A and D).

Fig. 6.

Age-structured analysis of TC burden in 2021 and global temporal trends, 1990–2021. Age-structured analysis of (A) incidents, (B) deaths, and (C) DALY cases and rates. Global temporal trends of (D) incident, (E) death, and (F) DALY cases. Global temporal trends of (G) ASIR, (H) ASDR, and (I) ASDALYR

The number of deaths from TC increased with age. In 2021, the age group spanning 70–74 years exhibited a peak number of mortalities at 2223.82 (95% UI, 1914.46–2460.32). The highest number of deaths from TC was observed among females aged 70–74 years, reaching 3679.72 (3147.42–4321.55). Conversely, males aged 75–79 years exhibited the highest mortality from TC, reaching 2577.47 (95% UI, 2110.77–2937.46). The highest incidence of DALY cases, 145,555.01 (95% UI, 120,929.87– 168,098.98), was observed in the 55–59 age group (Fig. 6B-C).

From 1990 to 2021, the number of incidents, deaths, and DALY cases increased in most age groups. Nevertheless, the incidence, deaths, and DALY rates have remained stable or slightly decreased over time, with some fluctuations in certain years. Furthermore, these rates were significantly higher in the age groups of 60 and above (Fig.s 6D–I).

RFs for TC

One of the RFs for mortality in patients with TC is high body mass index (BMI). Globally, the proportion of deaths because of BMI in patients with TC was 11.72% (95% UI, 8.84–14.58). Among the 21 geographical regions, the highest proportion was in North Africa and the Middle East, at 17.41% (95% UI, 13.19–21.35; Fig. 7A). The effect was most pronounced in patients with TC aged 50–54 years, 12.61% (95% UI, 9.52–15.76), and 55–59 years. A minimal impact of 6.97% (95% UI, 5.30–9.04) was observed in patients with TC aged 20–24 years. High BMI has always affected all age groups, and its effect increases with age, gradually decreasing after age 59 years but gradually increasing from 85 years of age (Fig. 7).

Fig. 7.

The RFs and temporal TC trends by age and 21 geographic regions. Proportions of (A), (C), and (E) deaths, as well as (B), (D), and (F) DALYs attributable to RFs in 21 geographic regions, different age groups, and global temporal trends, respectively

Global trends of TC predicted by the BAPC model

According to the forecast data, the overall trend indicates a slight increase in the ASIR. Specifically, the global ASIR was projected to rise from 3.00 (95% UI, 2.92–3.08) in 2022 to 3.62 (95% UI, 3.26–3.97) in 2035 (Fig. 8A). It was predicted that the ASDR may decrease in 2035 compared to 2022, with values of approximately 0.59 (95% UI, 0.58–0.60) in 2022 and 0.57 (95% UI, 0.54–0.60) in 2035, although there may be minor variations (Fig. 8B). We also evaluated the projected trends of the ASIR and ASDR across different age groups from 2022 to 2035.

Fig. 8.

Global trends of TC in age-standardized rates (per 100,000 population) from 2022 to 2035 using the BAPC models. (A) ASIR; (B) ASDR; (C) ASDALYR. The dashed portion on the right-hand side of the graph represents the forecasted data and its uncertainty range

Discussion

This study provides a comprehensive overview of the global burden of thyroid cancer using the most recent GBD 2021 data. From 1990 to 2021, the worldwide ASIR of TC increased steadily. Moreover, TC is more common in females, leading to a higher incidence and mortality rate than in males. The gender difference may be associated with sex hormone levels, which may be involved in tumor development by promoting stem cell self-renewal. The biological response to estrogen in females mediates pathways differently than in males [13], potentially reflecting the gender imbalance in tumor incidence and development. This could possibly be used to develop sex-specific therapies.

Between 1990 and 2021, the number of deaths and DALY due to TC substantially increased. However, ADSR and ASDALYR generally present a downward trend, consistent with the results of other studies; therefore, we speculate this is associated with an increase in the global population, the aging of the population, and the advancement of diagnosis and treatment. These results underscore the importance of ongoing assessment and enhanced prevention to guarantee alignment with prevailing population fluctuations and healthcare methodologies.

Based on the database, the medium SDI region experienced the highest number of TC cases and deaths, with the fastest increase from 1990 to 2021. This may be attributed to its large population and relatively delayed healthcare development. In contrast, high SDI region showed lower mortality rates due to advanced diagnostic and therapeutic technologies. The number of TC cases and deaths increased with age; therefore, it is crucial to diagnose and treat TC in middle-aged and older adults in the future. The number of incidences, deaths, DALY, AISR, ADSR, and ASDALYR among China, India, Saudi Arabia, and Ethiopia were the highest. Developing and implementing treatment interventions is essential to effectively mitigate the TC burden.

Previous studies have demonstrated the incidence of TC is related to geographical factors, population ethnicity, gender, weight factors, radiation exposure, abnormal iodine intake, heredity, gene mutations, and pathological types [3]. However, within the GBD 2021 framework, high body mass index was the only risk factor quantified for thyroid cancer–related mortality and DALYs, reflecting inherent limitations of the database, which does not incorporate more detailed biological, genetic, or molecular risk information. Obesity is an important factor in the development of TC [14]. The core mechanism is energy metabolism disorder and the interaction between TC and adipose tissue [15]. The thyroid gland can regulate adipose tissue’s function by affecting glucose and lipids’ metabolism and the adipose tissue’s mitochondrial function, thereby alleviating obesity and metabolic syndromes. Recently, the effect of adipose tissue on the thyroid gland has also begun to attract attention, as adipose tissue can induce chronic inflammation in obesity by secreting various adipokines and acts on thyroid tissue to cause thyroid nodules, TC, dysfunction, and other diseases. Studying the relationship between adipose tissue and the thyroid gland can enhance our knowledge of metabolism-related diseases, provide insights into how the body regulates total energy metabolism, and address the issues of energy metabolism imbalance from the root [16–19].

This study has some limitations. First, it relied on GBD data, so the accuracy and robustness of the estimates may be affected by the quality of the original registration data, particularly in low-income settings where underreporting of TC may skew the results. Nevertheless, this bias has been partially reduced by mapping diverse coding systems into the GBD framework. The differences in data coverage in different countries and the possible bias in the interpretation of the results suggest that it needs to be validated in the future by combining multicenter registry data and prospective cohorts. Second, the predictive model did not incorporate most risk factors. Among the established RFs, only high BMI was included in the GBD 2021 database. Due to limited data, we were unable to stratify the burden and trend of TC by histological subtypes such as papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). Third, growing awareness of overdiagnosis has led to adjustments in screening strategies worldwide, which may result in a slight decrease in TC incidence in certain regions and thus affect future projections. Despite these limitations, by leveraging updated data and advanced modeling approaches, our study provides an enhanced perspective on the historical and prospective burden of thyroid cancer. In conclusion, the paradox of rising TC incidence despite increased awareness of overdiagnosis, and the growing number of patients driven by high incidence but low mortality, warrant further investigation.

Conclusions

This study investigates TC global incidence, deaths, and DALY across regions and age groups and forecasts ASIR trends through 2035. Despite the increasing incidence and declining mortality of thyroid cancer, the overall disease burden remains substantial and varies widely across countries, regions, and age groups. The findings of this study highlight the need to strengthen public health strategies focused on reducing obesity and enhancing comprehensive cancer control, with tailored early diagnosis initiatives for high-risk groups. These strategies are particularly urgent in middle-SDI regions and other areas with rapidly rising incidence.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

TC

Thyroid cancer

GBD

Global burden of disease

DALYs

Disability-adjusted life years

ASR

Age-standardized rate

UI

Uncertainty interval

CI

Confidence interval

EAPC

Estimated annual percentage change

ASIR

Age-standardized incidence rate

ASDR

Age-standardized death rate

ASDALYR

Age-standardized disability-adjusted life years rate

SDI

Sociodemographic Index

BMI

Body mass index

BAPC

Bayesian age-period-cohort analysis

PTC

Papillary thyroid carcinoma

FTC

Follicular thyroid carcinoma

Author contributions

Long Wang: writing–original draft (lead) and data curation. Rong Li: writing–review and editing and project administration Xiaohua Zeng: investigation Huan Zhang: formal analysis.

Funding

This project received backing from the Chongqing Talent Program (CQYC20200303137-cstc2021ycjh-bgzxm0193), Chongqing Municipal Health and Health Commission (2019NLTS005), Special Project for Performance Incentive at Chongqing Research Institute, Scientific Research Capability Enhancement Project at Chongqing University Cancer Hospital (2023nlts011), Beijing Science and Technology Innovation Medical Development Foundation (KC2021-JF-0167-15), Special Key Projects for Technological Innovation and Application Development in Chongqing (CSTB2023TIAD-KPX0049-5), Beijing Medical Award Foundation (YXJL-2022-0435-0368), Natural Science Foundation of Chongqing (cstc2021jcyj-msxmX0341), and Chongqing science and health joint medical research project (2023MSXM103).

Data availability

As the Methods section outlined, the study data are open to access through the GBD 2021 online database.

Declarations

Ethics approval

Obtaining and using anonymized, publically available epidemiologic data from the database does not necessitate ethical approval or patient-informed consent.

Competing interests

The authors declare no competing interests.