Abstract:

Differentiated thyroid carcinoma (DTC) generally has a favorable prognosis. Most patients with DTC achieve good outcomes with surgery combined with radioactive iodine (RAI) therapy, with a 10-year survival rate exceeding 90%. However, about 5%-10% of patients develop unresectable local disease or distant metastases during the course of treatment, and may even gradually progress to a radioiodine-refractory (RAIR) state. For these advanced and inoperable patients, traditional treatments are difficult to control disease progression, making systemic drug therapy the mainstay of treatment. Over the past decade, significant advances in molecular targeted therapy and immunotherapy have transformed the landscape of advanced DTC. The2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer (abbreviation ATA guideline) propose a precision treatment model centered on molecular subtyping. This article compares the main differences in systemic therapy for advanced DTC between the 2015 and 2025 ATA guidelines, and, by integrating key clinical trials and real-world data, analyzes the evolution of treatment strategies over the past ten years and future directions.

Key words: Advanced differentiated thyroid cancer, Target therapy, Immunotherapy, Adverse events