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Marco Marino Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Valentina Cirello Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Valentina Gnarini Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Carla Colombo Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Elisa Pignatti Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Livio Casarini Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Chiara Diazzi Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Vincenzo Rochira Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Katia Cioni Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Bruno Madeo Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Cesare Carani Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Manuela Simoni Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Laura Fugazzola Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy
Unit and Chair of Endocrinology and Metabolism, Center for Genomic Research, Department of Clinical Sciences and Community Health, Endocrine Unit, Azienda USL of Modena, NOCSAE, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Modena, Italy

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Introduction Thyroid cancers can be well-differentiated, as papillary and follicular subtypes, or poorly differentiated and anaplastic carcinomas. Papillary thyroid carcinoma (PTC) represents up to 80% of all the thyroid cancer cases. Various

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Alessandro Brancatella Endocrine Unit 1, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Claudio Marcocci Endocrine Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Introduction Thyroid hormones are one of the most prescribed drugs in Western countries, mostly for the management of hypothyroidism either spontaneous or after thyroidectomy for benign diseases and differentiated thyroid cancer (DTC). The aim

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Yuntao Song Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China

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Jiaxin Wang Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China

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Yanli Zhu Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China

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Guohui Xu Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China

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Tianxiao Wang Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China

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Bin Zhang Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China

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Introduction The incidence-based mortality rates of thyroid cancer continued to increase over the past few decades, with papillary thyroid cancer (PTC) being the most common histology ( 1 ). Recurrent or persistent metastasis of the neck lymph

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Mubashir Mulla Department of Endocrine Surgery, King College London, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
Department of Endocrine Surgery, King College London, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, UK

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Klaus-Martin Schulte Department of Endocrine Surgery, King College London, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
Department of Endocrine Surgery, King College London, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
Department of Endocrine Surgery, King College London, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, UK

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Introduction Papillary thyroid cancer (PTC) is the most common thyroid cancer. Metastases from PTC most commonly involve the cervical lymph nodes (CLNs). The incidence of CLN metastases (CLNM) is reported between 30 and 80% (1, 2) . Some studies

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Thomas Crezee Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands

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Mirela Petrulea Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

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Doina Piciu Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

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Martin Jaeger Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands
Department of Nuclear Medicine and Endocrine Tumors, Institute of Oncology ‘Prof. Dr. Ion Chiricuta’, Cluj-Napoca, Romania

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Jan W A Smit Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

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Theo S Plantinga Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
Department of Nuclear Medicine and Endocrine Tumors, Institute of Oncology ‘Prof. Dr. Ion Chiricuta’, Cluj-Napoca, Romania

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Carmen E Georgescu Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Endocrinology Clinic, Cluj County Emergency Hospital, Cluj-Napoca, Romania

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Romana Netea-Maier Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands
Department of Nuclear Medicine and Endocrine Tumors, Institute of Oncology ‘Prof. Dr. Ion Chiricuta’, Cluj-Napoca, Romania

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Background In recent years, the incidence of non-medullary thyroid cancer (NMTC) has steadily increased ( 1 , 2 , 3 , 4 ). Although most NMTC patients have a favorable prognosis, 20–30% of patients with locally advanced or metastatic

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Jes Sloth Mathiesen Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Jens Peter Kroustrup Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark

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Peter Vestergaard Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Steno Diabetes Center North Jutland, Aalborg, Denmark

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Per Løgstrup Poulsen Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark

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Åse Krogh Rasmussen Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark

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Ulla Feldt-Rasmussen Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark

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Sten Schytte Department of ORL Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark

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Stefano Christian Londero Department of ORL Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark

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Henrik Baymler Pedersen Department of ORL Head & Neck Surgery, Aalborg University Hospital, Aalborg, Denmark

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Christoffer Holst Hahn Department of ORL Head & Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark

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Jens Bentzen Department of Oncology, Herlev Hospital, Herlev, Denmark

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Sören Möller Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark

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Mette Gaustadnes Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark

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Maria Rossing Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark

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Finn Cilius Nielsen Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark

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Kim Brixen Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Christian Godballe Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark

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Danish Thyroid Cancer Group (DATHYRCA)
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between January 1960 and December 2014, was constructed through three nationwide registries: the Danish Thyroid Cancer Database, the Danish Cancer Registry and the Danish Pathology Register ( 13 , 14 , 15 ). This has been described in detail previously

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Jes Sloth Mathiesen Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Jens Peter Kroustrup Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark

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Peter Vestergaard Department of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark

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Kirstine Stochholm Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
Center for Rare Diseases, Aarhus University Hospital, Aarhus N, Denmark

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Per Løgstrup Poulsen Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark

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Åse Krogh Rasmussen Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark

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Ulla Feldt-Rasmussen Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark

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Sten Schytte Department of ORL Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark

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Stefano Christian Londero Department of ORL Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark

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Henrik Baymler Pedersen Department of ORL Head & Neck Surgery, Aalborg University Hospital, Aalborg, Denmark

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Christoffer Holst Hahn Department of ORL Head & Neck Surgery, Copenhagen University Hospital, Copenhagen, Denmark

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Bjarki Ditlev Djurhuus Department of ORL Head & Neck Surgery, Zealand University Hospital, Køge, Denmark

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Jens Bentzen Department of Oncology, Herlev Hospital, Herlev, Denmark

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Sören Möller Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark

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Mette Gaustadnes Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark

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Maria Rossing Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark

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Finn Cilius Nielsen Center for Genomic Medicine, Copenhagen University Hospital, Copenhagen, Denmark

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Kim Brixen Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Anja Lisbeth Frederiksen Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Genetics, Odense University Hospital, Odense, Denmark

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Christian Godballe Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark

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the Danish Thyroid Cancer Group (DATHYRCA)
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/17801). Methods The MTC cohort was based on the Danish Cancer Registry, the Danish Pathology Register and the Danish Thyroid Cancer Database, which have prospectively collected data since 1943, 1968 and 1996, respectively. The first year, in which registration

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Mahmoud Al-Masri Department of Surgery, King Hussein Cancer Center, Amman, Jordan

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Tawfiq Al-Shobaki Department of Surgery, King Hussein Cancer Center, Amman, Jordan

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Hani Al-Najjar Department of Surgery, King Hussein Cancer Center, Amman, Jordan

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Rafal Iskanderian Department of Surgery, King Hussein Cancer Center, Amman, Jordan

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Enas Younis Department of Internal Medicine, Endocrine, King Hussein Cancer Center, Amman, Jordan

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Niveen Abdallah Department of Cell Therapy & Applied Genomics, King Hussein Cancer Center, Amman, Jordan

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Abdelghani Tbakhi Department of Cell Therapy & Applied Genomics, King Hussein Cancer Center, Amman, Jordan

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Hussam Haddad Department of Pathology & Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan

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Mohammad Al-Masri School of Medicine, University of Jordan, Amman, Jordan

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Zeinab Obeid Department of Surgery, King Hussein Cancer Center, Amman, Jordan

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Awad Jarrar Department of Surgery, King Hussein Cancer Center, Amman, Jordan

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Introduction Papillary thyroid carcinoma (PTC) is the most prevalent subtype of thyroid cancer accounting for approximately 85–88% of cases. The incidence of PTC is rapidly increasing, in contrast to other subtypes ( 1 ). The increase in the

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Philippe Thuillier Department of Endocrinology, University Hospital of Brest, Brest, France
EA GETBO 3878, University Hospital of Brest, Brest, France

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Nathalie Roudaut Department of Endocrinology, University Hospital of Brest, Brest, France
EA GETBO 3878, University Hospital of Brest, Brest, France

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Geneviève Crouzeix Department of Endocrinology, University Hospital of Brest, Brest, France
EA GETBO 3878, University Hospital of Brest, Brest, France

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Marie Cavarec EA GETBO 3878, University Hospital of Brest, Brest, France
Department of Nuclear Medicine, University Hospital of Brest, Brest, France

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Philippe Robin EA GETBO 3878, University Hospital of Brest, Brest, France
Department of Nuclear Medicine, University Hospital of Brest, Brest, France

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Ronan Abgral EA GETBO 3878, University Hospital of Brest, Brest, France
Department of Nuclear Medicine, University Hospital of Brest, Brest, France

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Véronique Kerlan Department of Endocrinology, University Hospital of Brest, Brest, France
EA GETBO 3878, University Hospital of Brest, Brest, France

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Pierre-Yves Salaun EA GETBO 3878, University Hospital of Brest, Brest, France
Department of Nuclear Medicine, University Hospital of Brest, Brest, France

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clinical thyroid cancer risk factors (age >65 years, male gender), PET–CT parameters (SUVmax median), US characteristics (4 majors malignancy criteria defined as presence of marked hypoechogenicity, irregular margins, more tall than wide dimension and

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M Ingenwerth Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany

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T Brandenburg Division of Laboratory Research, Department of Endocrinology, Diabetes and Metabolism and Clinical Chemistry, University Hospital Essen, University of Duisburg-Essen, Germany

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D Führer-Sakel Division of Laboratory Research, Department of Endocrinology, Diabetes and Metabolism and Clinical Chemistry, University Hospital Essen, University of Duisburg-Essen, Germany

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M Goetz Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany

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F Weber Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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H Dralle Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

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H-U Schildhaus Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany

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K W Schmid Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany

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S Theurer Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany

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thyroid cancer-associated deaths ( 1 , 2 ). They can occur either as part of hereditary syndromes (<30% of all MTC) in multiple endocrine neoplasias (MEN) 2A or 2B with germline mutations in the RET proto-oncogene or as sporadic tumors with approximately

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