Elevated suicide risk in thyroid cancer patients: determining mortality rates and identifying predictive factors using Surveillance, Epidemiology, and End Results (SEER) data.

Background: Despite thyroid cancer's favorable prognosis, population-level data on suicide risk and predictive factors remain limited, necessitating targeted mental health interventions. Patients experience significant psychological distress due to diagnostic/treatment uncertainties, particularly in the active surveillance era. This study quantified suicide mortality and identified risk predictors among US thyroid cancer patients.

Methods: We analyzed 328,264 histologically confirmed thyroid cancer patients [International Classification of Diseases for Oncology (ICD-O) C73.9] from the Surveillance, Epidemiology and End Results (SEER) database (2000-2021). Exclusions: non-suicide deaths, cases without microscopic confirmation, and incomplete records. We calculated standardized mortality ratios (SMRs) versus the general population and analyzed demographic (age, sex, race, income) and clinical predictors (stage, treatment history, tumor sequence) using Cox regression. A nomogram was developed from significant predictors and internally validated.

Results: Among 328,264 patients (75.3% female; median age 48 years), 282 died by suicide, yielding an SMR of 1.24 [95% confidence interval (CI): 0.72-1.99]. Key high-risk subgroups included males [hazard ratio (HR) =1.93], patients aged 10-39 years, and those diagnosed between 2016-2020 (HR =6.17). The nomogram demonstrated good predictive accuracy, with a C-index of 0.795.

Conclusions: Thyroid cancer patients show elevated suicide risk, particularly young males and recent diagnoses. While the nomogram may help identify high-risk subgroups, its clinical utility requires external validation and integration with psychosocial assessments.