Papillary thyroid carcinoma with confirmed distant metastases — most commonly involving the lungs or bone. This presentation requires a targeted treatment strategy that accounts for the sites of spread and the biological behaviour of the metastatic lesions.
Management centres on radioactive iodine (RAI) therapy, given following TSH stimulation, with hormonal suppression maintained between treatment cycles. The full protocol — including patient selection, treatment sequencing, interval scheduling, and monitoring requirements — is detailed in the complete regimen.
The primary clinical targets are sustained TSH suppression and the absence of structural disease progression on cross-sectional imaging between treatment cycles.
DOI: 10.1093/annonc/mdz400
Patients with distant metastases should receive 100–200 mCi (3.7–7.4 GBq) of 131I after TSH stimulation.
If the distant metastases are RAI-avid, 131I is administered every 6 months for 2 years and less frequently thereafter.
Between treatments, suppressive doses of levothyroxine are given to maintain serum TSH levels below 0.1 mIU/ml (unless there are specific contraindications).
Between treatments, efficacy should be verified with periodic cross-sectional imaging studies.