In this episode, we review recommendations 57 to 72 from the 2025 American Thyroid Association guidelines on the management of radioiodine avid and radioiodine refractory differentiated thyroid cancer.
Key topics include:

• The role of RAI therapy for iodine avid bone metastases and rising thyroglobulin levels

• Criteria and management strategies for RAIR disease

• Monitoring and follow up of stable or progressive RAIR metastatic DTC

• Indications for molecular testing and tissue based biomarker assessment

• Recommended systemic therapies including multikinase inhibitors (lenvatinib, sorafenib, cabozantinib)

• Targeted therapies for NTRK, RET, ALK, and BRAFV600E mutations

• Dose management, adverse event monitoring, and strategies for treatment sequencing

• The importance of tumor biopsy and next-generation sequencing to guide therapy for resistant disease