Thyroid cancer (TC) remains a prevalent malignancy, with over 820,000 global cases diagnosed in 2022. Differentiated thyroid carcinoma (DTC), primarily papillary and follicular types, accounts for most cases and has a favorable prognosis with total thyroidectomy and radioiodine (RAI) ablation. However, 5–15% of patients develop RAI-refractory (RAI-R) disease, leading to a significantly poorer outcome. For RAI-R patients, treatment decisions depend on disease progression. Active surveillance is suitable for indolent cases, while symptomatic or progressive disease requires systemic therapy. Multikinase inhibitors (MKIs) such as lenvatinib and sorafenib serve as first-line options, with cabozantinib recently approved for resistant cases. Additionally, novel targeted therapies, including RET and NTRK inhibitors, and immune checkpoint inhibitors, are under investigation, offering a personalized approach. A key challenge is determining the optimal timing for systemic therapy, balancing progression-free survival (PFS) benefits against MKI-related toxicities, which significantly impact quality of life (QoL). Molecular testing can identify actionable mutations, guiding therapy selection. Clinical guidelines (ATA, ESMO) recommend initiating treatment based on disease progression and patient condition, integrating strategies such as active surveillance, surgery, and radiotherapy when appropriate. Despite advances, systemic therapies carry significant adverse events (e.g., hypertension, fatigue, gastrointestinal toxicity), necessitating careful monitoring to prevent dose reductions or interruptions. A multidisciplinary approach is essential to optimize patient outcomes and maintain QoL. As targeted therapies continue to evolve, further research is needed to refine treatment sequencing and improve outcomes for RAI-R TC. This review synthesizes current evidence to guide clinical decision-making.
甲状腺癌（TC）仍是全球高发恶性肿瘤，2022年新确诊病例超过82万例。分化型甲状腺癌（DTC）以乳头状癌和滤泡状癌为主，占绝大多数病例，通过甲状腺全切除术和放射性碘（RAI）消融治疗可获得良好预后。然而，5%-15%的患者会发展为RAI难治性（RAI-R）疾病，导致临床结局显著恶化。针对RAI-R患者，治疗决策需依据疾病进展程度：惰性病例适合主动监测，而有症状或进展性疾病则需系统治疗。以乐伐替尼和索拉非尼为代表的多激酶抑制剂（MKIs）作为一线选择，卡博替尼近期获批用于耐药病例。此外，包括RET/NTRK抑制剂和免疫检查点抑制剂在内的新型靶向疗法正处于研究阶段，为个体化治疗提供可能。当前核心挑战在于确定系统治疗的最佳时机，需在无进展生存期（PFS）获益与严重影响生活质量（QoL）的MKI相关毒性间取得平衡。分子检测可识别可干预突变，指导治疗方案选择。临床指南（ATA、ESMO）建议根据疾病进展和患者状况启动治疗，适时整合主动监测、手术及放疗等策略。尽管治疗不断进步，系统疗法仍存在显著不良反应（如高血压、疲劳、胃肠道毒性），需严密监测以避免剂量调整或治疗中断。多学科协作对优化患者预后及维持生活质量至关重要。随着靶向治疗持续发展，仍需进一步研究以完善治疗序贯策略，改善RAI-R甲状腺癌的临床结局。本综述整合现有证据，旨在为临床决策提供指导。
肿瘤(癌症)患者之家