Thyroid Cancer, Risk Factors, Clinical Features, Prognosis, and its Incidence Preference in Saudi populations: Review


  • Amani Alhozali Department of Medicine, King Abdul-Aziz University Jeddah, Saudi Arabia



Hypothyroidism, thyroid cancer, hormones, TSH, Cyclooxygenase-2


Within the diverse cancers reported, the epidemiology of thyroid cancer increased 3-fold in the latest years which may be due lifestyle changes, lack of cancer awareness, lack of screening, and early cancer investigations and detection programs in addition to genetics and deficiency of iodine and vitamin D.  The aim of this review was to discuss Thyroid cancer incidence, risk factors, and clinical features and prognosis. The cause of thyroid cancer is unknown, but because the thyroid gland is very sensitive to radiation, exposure to radiation can cause precancerous changes. For unclear reasons, thyroid cancer like almost all diseases of the thyroid, occurs about 3 times more often in women than in men at any age, but the risk peaks earlier for women at 40 to 50 years. Several inherited conditions have been linked to different types of thyroid cancer but some patients with thyroid cancer do not have inherited conditions or a family history of the disease. Four general types of thyroid cancer were explained, Papillary, Follicular, Medullary, and Anaplastic. Over the last decade, the incidence of Papillary and Follicular thyroid cancers increased at the same time.


Simard E.P., Ward E.M., Siegel R., Jemal A. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J. Clin. 2012;62:118–128. doi: 10.3322/caac.20141.

Dong WW, Zhang DL, Wang ZH, Lv CZ, Zhang P, Zhang H. Different types of diabetes mellitus and risk of thyroid cancer: A meta-analysis of cohort studies. Front Endocrinol (Lausanne). 2022 Sep 23;13:971213.

Cheng SP, Liu CL, Hsu YC, et al. Expression and biologic significance of adiponectin receptors in papillary thyroid carcinoma. Cell Biochem Biophys. 2013; 65:203–10.

Cheng Q., Li X., Acharya C. R., Hyslop T., Ann Sosa J. A novel integrative risk index of papillary thyroid cancer progression combining genomic alterations and clinical factors. Oncotarget. 2017; 8:16690–16703.

Cheng F., Xiao J., Shao C., Huang F., Wang L., Ju Y., Jia H. Burden of Thyroid Cancer From 1990 to 2019 and Projections of Incidence and Mortality Until 2039 in China: Findings From Global Burden of Disease Study. Front. Endocrinol. 2021;12:738213.

Albores-Saavedra J, Henson DE, Glazer E, Schwartz AM. Changing patterns in the incidence and survival of thyroid cancer with follicular phenotype–papillary, follicular, and anaplastic: a morphological and epidemiological study. Endocr Pathol. 2007;18:1–7.

Ferlay J., Ervik M., Lam F., Colombet M., Mery L., Piñeros M., Znaor A., Soerjomataram I., Bray F. Global Cancer Ob-servatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Int. Agency Res. Cancer, 2020.

Ferlay J, Colombet M,Soerjomataram I, et al. Cancer statistics for the year 2020: Anoverview. Int. J. Cancer. 2021;149:778–789.

Alexander EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, Friedman L, Kloos RT, LiVolsi VA, Mandel SJ, et al. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med. 2012;367:705– 715.

Fritz A.G., Ries L.A.G. SEER Program Code Manual. Bethesda: Cancer Statistics Branch, Surveillance Program, Div of Cancer Control and Pop Sciences, National Cancer Institute, National Institutes of Health. Public Health Service, US Dept of Health and Human Services; Rockville, MD, USA: 1998. p. 3.

Cao Y., Wang Z., Gu J., Hu F., Qi Y., Yin Q., Sun Q., Li G., Quan B. Reproductive Factors but Not Hormonal Factors Associated with Thyroid Cancer Risk: A Systematic Review and Meta-Analysis. Biomed Res. Int. 2015; 2015:103515.

Alzahrani A.S., AlOmar H., Alzahrani N. Thyroid Cancer in Saudi Arabia: A Histopathological and Outcome Study. Int. J. Endocrinol. 2017:8423147.

Alqahtani W.S., Almufareh N.A., Domiaty D.M., Albasher G., Alduwish M.A., Alkhalaf H., Almuzzaini B., Al-Marshidy S.S., Alfraihi R., Elasbali A.M., et al. Epidemiology of cancer in Saudi Arabia thru 2010-2019: A systematic review with con-strained meta-analysis. Aims Public Health. 2020;7:679–696.

Mortality G.B.D., Causes of Death C. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 385:117–171.

Al-Hakami H.A., Alqahtani R., Alahmadi A., Almutairi D., Algarni M., Alandejani T. Thyroid Nodule Size and Prediction of Cancer: A Study at Tertiary Care Hospital in Saudi Arabia. Cureus. 2020; 12:e7478.

Flemban, A.F.; Kabrah, S.; Alahmadi, H.; Alqurashi, R.K.; Turaes, A.S.; Almaghrabi, R.; Al Harbi, S.; Khogeer, A.A. Patterns of Thyroid Cancer Mortality and Incidence in Saudi Arabia: A 30-Year Study. Diagnostics 2022, 12, 2716.

He L.-Z., Zeng T.-S., Pu L., Pan S.-X., Xia W.-F., Chen L.-L. Thyroid Hormones, Autoantibodies, Ultrasonography, and Clinical Parameters for Predicting Thyroid Cancer. Int. J. Endocrinol. 2016; 2016:8215834.

Aschebrook-Kilfoy B., Ward M.H., Della Valle C.T., Friesen M.C. Occupation and thyroid cancer. Occup. Environ. Med. 2014; 71:366–380.

Deng Y., Li H., Wang M., Li N., Tian T., Wu Y., Xu P., Yang S., Zhai Z., Zhou L., et al. Global Burden of Thyroid Cancer From 1990 to 2017. Jama Netw. Open. 2020; 3:e208759.

Alamoudi O., Hamour O.A., Mudawi I., Khayyat E., Batwail N., Elhadd T.A. Consensus-based management of differentiated thyroid cancer in a tertiary care set-up. Int. J. Surg. 2011; 9:96–100.

Hallquist A., Hardell L., Degerman A., Boquist L. Occupational exposures and thyroid cancer: Results of a case-control study. Eur. J. Cancer Prev. 1993; 2:345–349.

Lope V., Pérez-Gómez B., Aragonés N., López-Abente G., Gustavsson P., Floderus B., Dosemeci M., Silva A., Pollán M. Occupational exposure to ionizing radiation and electromagnetic fields in relation to the risk of thyroid cancer in Sweden. Scand. J. Work. Environ. Health. 2006; 32:276–284.

Tamam N., Almuqrin A.H., Mansour S., Elnour A., Musa M., Omer H., Sulieman A., Bradley D. Occupational and patients effective radiation doses in dental imaging. Appl. Radiat. Isot., 2021;177:109899.

Freeman L.E.B., Rusiecki J.A., Hoppin J.A., Lubin J.H., Koutros S., Andreotti G., Zahm S.H., Hines C.J., Coble J.B., Barone-Adesi F. Atrazine and cancer incidence among pesticide applicators in the agricultural health study (1994–2007) Environ. Health Perspect. 2011;119:1253–1259.

Boas M., Feldt-Rasmussen U., Skakkebæk N.E., Main K.M. Environmental chemicals and thyroid function. Eur. J. Endocrinol. 2006;154:599–611.

Boas M., Main K.M., Feldt-Rasmussen U. Environmental chemicals and thyroid function: An update. Curr. Opin. Endocrinol. Diabetes Obes. 2009;16:385–391.

Fielding J.R., Major N.M., Mullan B.F., Neutze J.A., Shaffer K., Wilcox C.B., Paynter L., Pisano E.D. Choosing a specialty in medicine: Female medical students and radiology. Ajr Am. J. Roentgenol. 2007;188:897–900.

Hussain F., Iqbal S., Mehmood A., Bazarbashi S., ElHassan T., Chaudhri N. Incidence of thyroid cancer in the Kingdom of Saudi Arabia, 2000–2010. Hematol. Oncol. Stem Cell Ther., 2013; 6:58–64.

Parsa A A and, Gharib H Thyroid Nodule: Current Evaluation and Management. The Thyroid and Its Diseases, 2019, p. 493–516.

Burns WR, Zeiger MA. Differentiated thyroid cancer. Semin Oncol. 2010 Dec; 37(6):557–66.

Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedus L, Vitti P. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. J Endocrinol Invest. 2010; 33:51–56.

Hsiao SJ, Nikiforov YE. Molecular approaches to thyroid cancer diagnosis. Endocr Relat Cancer. 2014, 21(5):T301–13.

Boice JD, Jr, Mandel JS, Doody MM, Yoder RC, McGowan R. A health survey of radiologic technologists. Cancer, 1992, 69:586–598.

Schneider DF, Mazeh H, Lubner SJ, Jaume JC, and Chen H. Chapter 71: Cancer of the Endocrine System. In: Niederhuber JE, Armitage JO,

Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier: 2014.

NCI (National Cancer Institute. Physician Data Query (PDQ). Thyroid Cancer Treatment. 02/06/2019. Accessed at on February 20, 2019.

NCCN (National Comprehensive Cancer Network). Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. V.3.2018. Accessed at professionals/physician_gls/pdf/thyroid.pdf

Davidge-Pitts CJ and Thompson GB. Chapter 82: Thyroid Tumors. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.

ACS (American Cancer Society). Cancer Facts and Figures. Atlanta: American Cancer Society; 2012.

Mullur R, Liu YY, Brent GA. Thyroid hormone regulation of metabolism. Physiol Rev., 2014; 94 (2):355–82.

Adeniran AJ, Zhu Z, Gandhi M, Steward DL, Fidler JP, Giordano TJ, Biddinger PW, Nikiforov YE. Correlation between genetic alterations and microscopic features, clinical manifestations, and prognostic characteristics of thyroid papillary carcinomas. Am J Surg Pathol. 2006; 30:216–222.

Agrawal, N., Jiao, Y., Sausen, M., Leary, R., Bettegowda, C., Roberts, N. J., ... & Ball, D. W. (2013). Exomic sequencing of medullary thyroid cancer reveals dominant and mutually exclusive oncogenic mutations in RET and RAS. The Journal of Clinical Endocrinology & Metabolism, 98(2), E364–E369.

Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K; International Agency for Research on Cancer Handbook Working Group. Body Fatness and Cancer–Viewpoint of the IARC Working Group. N Engl J Med. 2016, 25 (8):794–8.

Alexander EK and Cibas ES. Diagnosis of thyroid nodules. Lancet Diabetes Endocrinol. 2022; 10:533–539.

Fazal Hussain, Samra Iqbal, Asif Mehmood, Shouki Bazarbashi, Tusneem ElHassan, Naeem Chaudhri, Incidence of thyroid cancer in the Kingdom of Saudi Arabia, 2000–2010, Hematology/Oncology and Stem Cell Therapy, Volume 6, Issue 2, 2013, Pages 58–64.

Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ. 2006. Cancer statistics, Cancer J Clin., 2006, 56:106–130.

Lubitz CC, Kong CY, McMahon PM, Daniels GH, Chen Y, Economopoulos KP, Gazelle GS, Weinstein MC. Annual financial impact of welldifferentiated thyroid cancer care in the United States. Cancer. 2014.120:1345–1352.

Soslow RA, Dannenberg AJ, Rush D, Woerner BM, Khan KN, Masferrer J, Koki AT. 2000. COX-2 is expressed in human pulmonary, colonic, and mammary tumors. Cancer, 89:2637–2645.

Huang M, Chen Q, Xiao J, Liu C, Zhao X. Prognostic significance of cyclooxygenase-2 in cervical cancer: a meta-analysis. Int J Cancer, 2013, 132:363–373.

Larson SD, Jackson LN, Riall TS, Uchida T, Thomas RP, Qiu S, Evers BM. Increased incidence of well-differentiated thyroid cancer associated with Hashimoto thyroiditis and the role of the PI3k/Akt pathway. J Am Coll Surg., 2007, 204:764–773.

Okayasu I, Fujiwara M, Hara Y, Tanaka Y, Rose NR. 1995. Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma. A study of surgical cases among Japanese, and white and African Americans. Cancer 76:2312–2318.

Cornetta AJ, Russell JP, Cunnane M, Keane WM, Rothstein JL. 2002. Cyclooxygenase-2 expression in human thyroid carcinoma and Hashimoto’s thyroiditis. Laryngoscope, 112:238–242.

Lo CY, Lam KY, Leung PP, Luk JM. 2005. High prevalence of cyclooxygenase 2 expression in papillary thyroid carcinoma. Eur J Endocrinol 152:545–550

Specht L. Oral complications in the head and neck radiation patient. Introduction and scope of the problem. Support Care Cancer. 2002; 10(1):36–9.

Ji B, Liu Y, Zhang P, Wang Y, Wang G. 2012. COX-2 expression and tumor angiogenesis in thyroid carcinoma patients among northeast Chinese population-result of a single-center study. Int J Med Sci., 9:237–242.

Siironen, P., Ristimäki, A., Nordling, S., Louhimo, J., Haapiainen, R., & Haglund, C. (2004). Expression of COX‐2 is increased with age in papillary thyroid cancer. Histopathology, 44(5), 490–497.

Kajita S, Ruebel KH, Casey MB, Nakamura N, Lloyd RV. Role of COX-2, thromboxane A2 synthase, and prostaglandin I2 synthase in papillary thyroid carcinoma growth. Mod Pathol., 2005, 18:221–227.

Scarpino S, Duranti E, Stoppacciaro A, Pilozzi E, Natoli G, Sciacchitano S, Luciani E, Ruco L. 2009. COX-2 is induced by HGF stimulation in Met-positive thyroid papillary carcinoma cells and is involved in tumour invasiveness. J Pathol., 218:487–494.

Chan AT, Giovannucci EL, Meyerhardt JA, Schernhammer ES, Curhan GC, Fuchs CS. 2005. Long-term use of aspirin and nonsteroidal antiinflammatory drugs and risk of colorectal cancer. JAMA 294:914–923.

Cuzick J, Otto F, Baron JA, Brown PH, Burn J, Greenwald P, Jankowski J, La Vecchia C, Meyskens F, Senn HJ, Thun M. Aspirin and non-steroidal anti-inflammatory drugs for cancer prevention: an international consensus statement. Lancet Oncol. 2009.10:501–507.

Patel D, Kitahara CM, Park Y, Liao LM, Linet M, Kebebew E, Nilubol N. Thyroid Cancer and Nonsteroidal Anti-Inflammatory Drug Use: A Pooled Analysis of Patients Older Than 40 Years of Age. Thyroid. 2015; 25(12):1355–62.

Ito Y, Yoshida H, Nakano K, Takamura Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuka F, Matsuura N, Kuma K, Miyauchi A. Cyclooxygenase-2 expression in thyroid neoplasms. Histopathology, 2003.42:492–497.

Hayes RB, Reding D, Kopp W, Subar AF, Bhat N, Rothman N, Caporaso N, Ziegler RG, Johnson CC, Weissfeld JL, Hoover RN, Hartge P, Palace C, Gohagan JK. 2000. Etiologic and early marker studies in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial. Control Clin Trials, 21:349S–355S.

Menter DG, Schilsky RL, DuBois RN. Cyclooxygenase-2 and cancer treatment: understanding the risk should be worth the reward. Clin Cancer Res., 2010. 16:1384–1390.

Udelsman R, Zhang Y. 2014. The epidemic of thyroid cancer in the United States: the role of endocrinologists and ultrasounds. Thyroid, 24:472–479.

Morris LG, Sikora AG, Tosteson TD, Davies L. 2013. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid, 23:885–891.

Arterburn DE, Maciejewski ML, Tsevat J. Impact of morbid obesity on medical expenditures in adults. Int J Obes (Lond), 200529:334–339.

Wang D, Dubois RN. 2010. The role of COX-2 in intestinal inflammation and colorectal cancer. Oncogene 29:781–788.

Kunadharaju R, Goyal G, Rudraraju A, Silberstein PT. New Treatment Options for Metastatic Thyroid Cancer. Fed Pract. 2015, 32(7):21S–26S.

Zabel EW, Alexander BH, Mongin SJ, Doody MM, Sigurdson AJ, Linet MS, Freedman DM, Hauptmann M, Mabuchi K, Ron E. 2006. Thyroid cancer and employment as a radiologic technologist. Int J Cancer, 119:1940–1945.

Daugherty SE, Pfeiffer RM, Sigurdson AJ, Hayes RB, Leitzmann M, Schatzkin A, Hollenbeck AR, Silverman DT. 2011. Nonsteroidal antiinflammatory drugs and bladder cancer: a pooled analysis. Am J Epidemiol., 173:721–730.




How to Cite

Alhozali, A. . (2023). Thyroid Cancer, Risk Factors, Clinical Features, Prognosis, and its Incidence Preference in Saudi populations: Review. Journal of Contemporary Medical Sciences, 9(6).