Abstract
BACKGROUND: Thyroid cancer incidence has risen steadily worldwide, making it one of the most common endocrine malignancies. Women of reproductive age experience rates roughly three times higher than men, a disparity increasingly attributed not only to hormonal factors but also to metabolic disturbances. Obesity, hyperglycemia and dyslipidemia may promote thyroid carcinogenesis via chronic hyperinsulinemia, altered adipokine signaling and low-grade inflammation. Yet the proportion of thyroid cancer burden in this group that is attributable to such modifiable metabolic risks has not been systematically quantified; our study therefore leverages GBD 2021 data to estimate this burden and project trends through 2050. METHODS: Data from the Global Burden of Disease Study 2021 were analyzed to estimate the mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) of thyroid cancer attributable to metabolic factors (TC-MRF) among females aged 20–49 years across 204 countries and territories from 1990 to 2021. Trends were evaluated using estimated annual percentage change (EAPC). Burden was further stratified by age group, Socio-demographic Index (SDI), region, and country. The burden from 2021 to 2050 was projected using an autoregressive integrated moving average (ARIMA) model. RESULTS: The global deaths and DALYs of thyroid cancer attributable to metabolic risk factors (TC–MRF) among female reached 3,225 and 88,120 respectively in 2021, reflecting a steady increase since 1990. The age-standardized DALY rate rose most rapidly among women aged 20–29. South Asia exhibited the highest EAPC in mortality and DALY rates, while high-SDI regions experienced a declining trend. Iran and Vietnam recorded the fastest growth in all burden indicators. Predictive models forecast a continued upward trajectory in TC–MRF burden through 2049. CONCLUSION: The global disease burden of TC–MRF in women of reproductive age has increased consistently over the past three decades and is projected to rise further. These findings highlight the urgent need for targeted interventions—such as metabolic screening, early detection, and region-specific obesity prevention strategies—to mitigate the future burden, especially in low- and middle-SDI countries, tailored to local healthcare policy and resources. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12905-025-04137-9.