Thyroid cancer incidence has continuously increased in recent decades, more than any other malignancy. According to the Surveillance, Epidemiology, and End Results (SEER) database, in the period 1980-2016, the incidence rate in the United States increased from 2.39 to 7.54 per 100 000 in men and from 6.15 to 21.28 per 100 000 in women (1). The increase in incidence is global, involving high-and low-income countries, regardless of variable diagnostic practices, ethnic characteristics, and environmental differences (2). A higher detection rate due to more sensitive and diffuse diagnostic practices certainly contributes to this increase, allowing the emergence of small and indolent tumors that are irrelevant to patients’ health and survival and that previously would have gone undiagnosed. Stable thyroid cancer-related mortality rate, at approximately 0.5 cases per 100 000 inhabitants, was believed to support an “apparent” increase in thyroid cancer incidence.

However, in recent decades, thyroid cancer has been diagnosed at an earlier stage (indicated by the progressive prevalence of small tumors) and is more efficaciously treated (indicated by the overall survival at 5 years, which increased from 92.1% in 1975-1977 to 98.5% in 2009-2015)(1). Early diagnosis and better treatment reduce cancer mortality: a steady death rate could be the final result of increasing mortality compensated by the decreasing trend due