{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:17:45Z","timestamp":1788171465721,"version":"build-2803163510"},"reference-count":85,"publisher":"BioExcel","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["DIC"],"abstract":"<jats:p>Differentiated thyroid cancer has a favourable clinical course. However, a minority of patients with distant metastases lose the ability for radioiodine uptake. In case of refractoriness, the implementation of local therapies, that is radiofrequency\/cryoablation or embolization, stabilizes metastasis and delays disease progression. A wait-and-see strategy can be a viable option in slow disease progression. On the other hand, in symptomatic patients with progressive disease, the alternative is systemic therapy with tyrosine kinase inhibitors. Three multi- kinase inhibitors have been approved for this indication: lenvatinib and sorafenib as a first-line option and cabozantinib as a second-line option. Next-generation sequencing allows identification of somatic genetic alterations in tumour tissue, some of which are druggable. Thus, additional selective inhibitors have been approved: larotrectinib and entrectinib for NTRK+ tumours, selpercatinib and pralsetinib for RET+ tumours, and crizotinib, alectinib and lorlatinib for ALK+ tumours. Such a personalized approach increases clinical benefit whilst minimizing adverse events. Future studies should focus on the combination of tyrosine kinase inhibitors and immunecheckpoint inhibitors; currently, there is no strong evidence that redifferentiation strategies add clinical benefit in terms of overall survival or progression-free survival.\n\nDownload the Plain Language Summary of this article: https:\/\/www.drugsincontext.com\/plain-language-summaries\/plain-language-summary-how-to-manage-radioiodine-refractory-thyroid-cancer-in-the-era-of-precision-medicine\n\nThis article is part of the How to manage thyroid diseases: from autoimmunity to malignancy Special Issue: https:\/\/www.drugsincontext.com\/special_issues\/how-to-manage-thyroid-diseases-from-autoimmunity-to-malignancy<\/jats:p>","DOI":"10.7573\/dic.2026-4-4","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:47:55Z","timestamp":1788169675000},"page":"1","source":"Crossref","is-referenced-by-count":0,"title":["How to manage radioiodine-refractory thyroid cancer in the era of precision medicine"],"prefix":"10.7573","author":[{"given":"Olga","family":"Karapanou","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00y1kmp77","id-type":"ROR","asserted-by":"publisher"}],"name":"NIMTS Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grigoris","family":"Effraimidis","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04v4g9h31","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Thessaly"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Michalaki","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/017wvtq80","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Patras"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Saltiki","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04gnjpq42","id-type":"ROR","asserted-by":"publisher"}],"name":"National and Kapodistrian University of Athens"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10047","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"1.\tFugazzola L, Elisei R, Fuhrer D, et al. 2019 European Thyroid Association Guidelines for the treatment and follow-up of advanced radioiodine-refractory thyroid cancer. 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