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. Bone metastases occur in 2-13% of thyroid cancers. Bone metastases occur in 7-28% of follicular adenocarcinoma and 1.4-7% of papillary adenocarcinoma. 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%). Most of them are osteolytic destruction, causing local pain. If the tumor tissue compresses the spinal cord, it may cause paralysis. Spinal metastasis of thyroid cancer requires comprehensive treatment of which 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 act, so 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 bolus provides rapid symptom relief but short maintenance Rutten et al. reported that 59% of patients had symptom relief and tumor progression slowed after treatment, but the efficacy lasted only 6.5 months. For long-term remission, multiple arterial embolizations need to be continued. 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%; whereas 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, younger patients are advised to choose a more aggressive surgical approach if possible. 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 diphosphonates, 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 of 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 postoperative iodine uptake test, 131I therapy is performed; for negative patients, external irradiation and/or chemotherapy is done.