With the recent changes in environment and living conditions as well as people’s concern about their health, the incidence of thyroid cancer is on the increase. Ninety percent of thyroid tumors are of differentiated type, among which papillary adenocarcinoma accounts for 70-75% and is common in young women; follicular adenocarcinoma accounts for 15-20% and is more common in middle-aged women. Other types of thyroid tumors, such as Hurthle cell carcinoma, undifferentiated adenocarcinoma and medullary carcinoma, only account for less than 10% of patients. About 90% of thyroid cancers present as thyroid nodules. Lobectomy or subtotal resection is performed after confirmation by puncture biopsy, and 131I (131 iodine) is given after surgery as needed. The prognosis of differentiated thyroid cancer is good, with a 10-year survival rate of 80-95%. Bone metastases occur in 2-13% of thyroid cancers. Bone metastases occur in 7-28% of follicular adenocarcinomas and 1.4-7% of papillary adenocarcinomas. 7-23% of patients develop metastases during the progression of the disease, while 1-3% of patients have bone metastases detected at the first visit. The spine is the most common site of bone metastases. The prognosis of metastatic thyroid cancer is significantly reduced, with the 10-year survival rate reaching less than 40%. The most common site of spinal metastases is the thoracic spine (60-80%), followed by the lumbar spine (15-30%) and the cervical spine (<10%). Osteolytic destruction is most common, causing local pain. If the tumor tissue compresses the spinal cord, paralysis may result. Metastases to the spine from thyroid cancer require a combination of treatments. Among them, radioactive iodine therapy (131I) is the main treatment. It can significantly reduce the pain. An iodine uptake test is required before treatment. If the lesion is able to take up iodine, the radioactive material can accumulate in the area of the lesion and therefore iodine uptake is an indicator of prognosis. If the lesion does not take up iodine, it indicates that the tumor has a tendency to become malignant and is resistant to radioactive iodine treatment. Therefore, radioactive iodine therapy is recommended for young papillary and follicular metastases with iodine uptake. After a positive iodine uptake test, a dose of 600mCi is given until the lesion is no longer iodine visualized. Radioactive doses exceeding 600 mCi are not recommended because of the risk of hematologic malignancy and abnormal salivary gland function. Selective arterial boluses provide rapid symptom relief but are short-lived. 59% of patients treated by Rutten et al. reported symptom relief and slowing of tumor progression, but efficacy lasted only 6.5 months. Multiple arterial embolizations need to be continued for long-term remission. We use selective arterial embolization primarily as a preoperative adjunct to reduce intraoperative bleeding. In addition, embolization causes ischemia of the tumor and synergistic effects can be obtained in combination with radiotherapy. Surgery is another important tool in the treatment of thyroid spinal metastases, with the main aim of rapidly eliminating intractable pain and resolving spinal cord compression and pathological fractures and instability. Depending on the patient's specific situation, surgical options of reduction surgery and complete tumor removal are available. The recurrence rate for reduction surgery is approximately 60%; while the recurrence rate for complete laminectomy is approximately 10%. The 5-year survival rate for complete resection of all metastases is approximately 70% compared to 30% for subtotal surgery. Therefore, a more aggressive surgical approach is recommended for younger patients. If the patient is elderly, or if the systemic condition does not allow surgical removal of the tumor, vertebroplasty may be an option for pain relief. There are also pharmacological treatments, such as bisphosphonates, that can improve pain and reduce the incidence of pathological fractures. Vascular endothelial growth factor receptor inhibitors (sorafenib) have been reported to increase tumor progression-free survival; external radiation combined with vascular endothelial growth factor therapy can improve survival rates. In short, surgery is recommended for patients with spinal metastases from thyroid cancer combined with intractable pain, neurological dysfunction and pathological fractures. Complete tumor resection of all metastases, such as total laminectomy of the entire block, is recommended in young patients. For positive iodine uptake test after surgery, 131I therapy is performed; for negative patients, external irradiation and/or chemotherapy is done. Those who are inoperable can be treated with external irradiation + chemotherapy + selective arterial embolization + small molecule drugs + diphosphonate drugs + vertebroplasty. Selective arterial embolization + small molecules + diphosphonates can be used as an adjuvant to any regimen. The patient, male, 55 years old , was found to have a destructive cervical lesion on examination , thyroidectomy (thyroid cancer) for 14 years and imaging showed a destructive C3 lesion with a C3 vertebral compression fracture. Preoperative arteriogram showed abundant blood supply to the tumor, so selective arterial embolization was performed. The surgical approach was a total C3 laminectomy with combined anterior and posterior approaches. Postoperative pathology suggested follicular adenocarcinoma. Postoperative radioiodine therapy + external radiation therapy was performed. The patient has been followed up for more than 4 years, the tumor is well controlled and the patient is living a normal life.