1.Distant metastasis from lung and bone; 2.Tumor break through the thyroid envelope; 3.Tumor diameter greater than 1 cm; 4.Tumor does not break through the thyroid envelope and the diameter is less than 1 cm, but there are lymph node metastasis, vascular infiltration, non-papillary carcinoma (follicular, low differentiation); 5.Papillary carcinoma of poor pathological subtypes (high cell, island cell, columnar cell, diffuse sclerosis, etc.); 6.Multiple tumor lesions; 7.History of radiation exposure.