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Practice Guideline
. 2025 Aug;52(10):3859-3876.
doi: 10.1007/s00259-025-07222-1. Epub 2025 Mar 25.

Chinese management guidelines for radioactive iodine-refractory differentiated thyroid cancer (2025 edition)

Yan-Song Lin  1 , Ren-Fei Wang  2 , Rui Huang  3 , Qiang Wen  4 , Wei Cao  5 , Li-Bo Chen  6 , Ye Guo  7 , Xiao-Rong Hou  8 , Li Li  9 , Xiao-Yi Li  10 , Cheng-He Lin  11 , Zhi-Yan Liu  12 , Hao Wang  13 , Xu-Fu Wang  14 , Zhuo-Ying Wang  15 , Xiao-Hong Wu  16 , Shu-Hang Xu  17 , Ai-Min Yang  18 , Bo Zhang  19 , Yue-Lun Zhang  20
Affiliations
Practice Guideline

Chinese management guidelines for radioactive iodine-refractory differentiated thyroid cancer (2025 edition)

Yan-Song Lin et al. Eur J Nucl Med Mol Imaging. 2025 Aug.

Abstract

Purpose: Radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) has become a challenge in clinical practice, particularly in China with a high incidence and undesirable survival outcome. Since the publication of first China consensus on the diagnosis and treatment of RAIR-DTC in 2019, significant and rapid advances have occurred in the field both in China and internationally. This guideline aims to inform Chinese clinicians, researchers, patients, and health policy makers on the latest evidence and recommendations, to further standardize the clinical diagnosis and treatment of RAIR-DTC.

Methods: The structured clinical questions addressed in this guideline were derived from clinical diagnostic and treatment processes, with references to study, prior guidelines, expert consensus, and systematic reviews, etc. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used for quantitative and qualitative evaluation of the evidence. The editorial process was completely independent of the guideline development group.

Results: The guideline addressed 26 clinical questions and formed 35 recommendations. In this guideline, the definition criteria for RAIR-DTC was optimized, prediction and identification was based on evidence including molecular testing, dynamic biochemical changes, and multimodal imaging. Comprehensive pre-treatment clinical evaluation was emphasized and tailored for individualized decision-making. The combination of systematic therapy and surgery, and the redifferentiation followed by RAI therapy were also reviewed and updated. Molecular imaging plays a unique role in the pre-assessing and therapeutic response evaluation for RAIR-DTC.

Conclusions: We have updated and developed evidence-based recommendations with the aim of providing scientific, rigorous, and comprehensive guidance for the clinical diagnosis and treatment of RAIR-DTC patients in China. We hope to share our guideline with colleagues out of China, with the expectation of further comments and suggestions.

Keywords: Chinese Society of Nuclear Medicine (CSNM); Committee Chinese Society of Clinical Oncology (CSCO); Guideline; Radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC); Thyroid oncology committee of China Anti-Cancer Association (CACA).

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Conflict of interest statement

Declarations. Ethical approval: This is guideline for management of radioactive iodine-refractory differentiated thyroid cancer and no ethical approval is required. Consent to participate: This is guideline for management of radioactive iodine-refractory differentiated thyroid cancer and no written informed consent is required. Consent to publish: Not applicable. Expert committee for guideline review: Jing Wang (Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University), Rui An (Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology), Chun-Mei Bai (Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College), Ruo-Chuan Cheng (Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University), Ju-Gao Fang (Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University), Ming Gao (Department of Thyroid and Breast Surgery, Tianjin Union Medical Center of Nankai University), Ming-Hua Ge (Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Ning-Yi Jiang (Department of Nuclear Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University), Lin Li (Department of Nuclear Medicine, West China Hospital, Sichuan University), Si-Jin Li (Department of Nuclear Medicine, First Hospital of Shanxi Medical University), Xing-Rui Li (The Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology), Ya-Ming Li (Department of Nuclear Medicine, the First Hospital of China Medical University), Jun Liang (Department of Oncology, Peking University International Hospital), Shao-Yan Liu (Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College), Quan-Yong Luo (Department of Nuclear Medicine, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine), Zhong-Yan Shan (Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University), Hong-Cheng Shi (Department of Nuclear Medicine, Zhongshan Hospital, Fudan university), Jian Tan (Department of Nuclear Medicine, Tianjin Medical University General Hospital), Wei-Ping Teng (Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University), Wen Tian (Department of Thyroid & Hernia Surgery, Medical Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital), Bai-Xuan Xu (Department of Nuclear Medicine, The First Medical Center of Chinese People’s Liberation Army General Hospital), Shi-Kai Wu (Department of Medical Oncology, Peking University First Hospital). Guideline secretary: Cong Shi (Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College), Yu-Qing Sun (Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College). Competing interests: The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Algorithm for the clinical management of patients with RAIR-DTC. a Local or systemic treatments can be considered if disease progression presents with associated symptoms, organ dysfunctions, or even life-threatening situations. b Other local treatments (such as external-beam radiation therapy, ablation, and particle implantation, etc.), systemic therapy followed by surgery, and systemic treatments
See this image and copyright information in PMC

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