finding of a medullary thyroid carcinoma in as high as 20% of cases. in europe where the threshold for thyroid surgery is lower than in the united states, an elaborate strategy that incorporates serum calcitonin measurements and stimulatory tests for calcitonin has been incorporated into the decision to perform a thyroidectomy; thyroid experts in the united states, looking at the same data, have for the most part not incorporated calcitonin testing as a routine part of their evaluations, thereby eliminating a large number of thyroidectomies and the consequent morbidity. the european thyroid community has focused on prevention of metastasis from small medullary thyroid carcinomas; the north american thyroid community has focused more on prevention of complications associated with thyroidectomy (see american thyroid association guidelines below). as demonstrated in the table below, individuals with stage iii and iv disease have a significant risk of dying from thyroid cancer. while many present with widely metastatic disease, an equal number evolve over years and decades from stage i or ii disease. physicians who manage thyroid cancer of any stage recognize that a small percentage of patients with low-risk thyroid cancer will progress to metastatic disease. improvements have been made in thyroid cancer treatment during recent years. the identification of some of the molecular or dna abnormalities has led to the development of therapies that target these molecular defects. the first of these agents to negotiate the approval process is vandetanib, a tyrosine kinase inhibitor that targets the ret proto-oncogene, two subtypes of the vascular endothelial growth factor receptor, and the epidermal growth factor receptor. more of these compounds are under investigation and are likely to make it through the approval process. for differentiated thyroid carcinoma, strategies are evolving to use selected types of targeted therapy to increase radioactive iodine uptake in papillary thyroid carcinomas that have lost the ability to concentrate iodide. this strategy would make possible the use of radioactive iodine therapy to treat "resistant" thyroid cancers. other targeted therapies are being evaluated, making life extension possible over the next 5–10 years for those with stage iii and iv thyroid cancer. prognosis is better in younger people than older ones. prognosis depends mainly on the type of cancer and cancer stage. thyroid cancer type5-year survival10-year survival stage istage iistage iiistage ivoveralloverall papillary 100%100%93%51%51%96% or 97%93% follicular 100%100%71%50%91%85% medullary 100%98%81%28%80%, 83% or 86%75% anaplastic (always stage iv)7%7% or 14%(no data) epidemiology thyroid cancer, in 2010, resulted in 36,000 deaths globally up from 24,000 in 1990. obesity may be associated with a higher incidence of thyroid cancer, but this relationship remains the subject of much debate. thyroid cancer accounts for less than 1% of cancer cases and deaths in the uk. around 2,700 people were diagnosed with thyroid cancer in the uk in 2011, and around 370 people died from the disease in 2012. however, in south korea, thyroid cancer was the 5th most prevalent cancer, which accounted for 7.7% of new cancer cases in 2020. notable cases jennifer grey american actress karen smyers american swimmer emre can, german footballer joe piscopo, american actor sofía vergara, american actress rod stewart, british singer julia volkova, russian singer daniel snyder, american owner of the washington football team danny new, co-host of daytime for wfla and previous host of mass appeal on wwlp. erica lugo, a coach on biggest loser television show. jerry dipoto, former major league baseball pitcher william rehnquist, chief justice of the united states (1986–2005) died september 3, 2005, from anaplastic thyroid cancer esther grace earl, avid nerdfighter (august 3, 1994 – august 25, 2010) died from papillary thyroid cancer that spread to the lungs uhm jung-hwa, south korean singer, actress and dancer lee moon-sae, south korean ballad singer vladimir putin, president of russia