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

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