Bone metastases are a recognised complication of follicular thyroid cancer and occur more frequently in this subtype than in papillary thyroid cancer. Their presence shapes both systemic and localised treatment decisions.
Follicular thyroid cancer carries a higher rate of bone metastases than papillary thyroid cancer (55.5% versus 31.5%, respectively). Multiple skeletal lesions raise specific concerns around pain, fracture risk, and skeletal-related events, making bone-directed management a central part of care in this setting.
Management of FTC with bone metastases may involve assessment of radioiodine avidity alongside bone-directed systemic and locoregional therapies — the full evidence-based regimen, decision criteria, and sequencing are detailed in the protocol.
Relief of bone pain, often achieved within 48–72 hours after radiotherapy.
Bone metastases are more common in FTC than in PTC (55.5% versus 31.5%, respectively).
Inhibition of bone resorption should be considered in TC patients with multiple bone metastases.
If the bone metastases are RAI-avid, RAI therapy may control the disease for some time and alleviate or delay symptoms, but it is unlikely to eliminate these lesions.
There is a strong rationale and some clinical data supporting the roles for bone resorption inhibitors (bisphosphonates or denosumab) [V, B], external beam radiotherapy (EBRT) or other locoregional treatments in reducing SREs.
Pain relief is often achieved 48–72 h after treatment, although it may take up to 1 month.
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