Step 1: Surgical excision This is a very important and decisive step. The principle is to remove as much of the lesion as can be seen by the naked eye without affecting the patient’s quality of life later. Step 2: radioactive iodine nail scavenging Treatment nail scavenging can be considered within 2-4 weeks after surgery, depending on the speed of wound healing. Before nail clearing, you need to abstain from iodine for four weeks and stop using thyroxine tablets for four weeks. Ouyang Wei, Department of Nuclear Medicine, Zhujiang Hospital, Southern Medical University The significance of nail clearing treatment is: (1) to remove small lesions in the residual thyroid gland; (2) to facilitate the diagnosis of metastases; and (3) to facilitate subsequent follow-up. Step 3: radioiodine treatment of metastases Three months after nail clearance, treatment of metastases can be performed. The treatment of metastases after nail clearance is very important. Its significance is: (1) to diagnose metastases throughout the patient’s body; (2) to treat not only lesions visible to the naked eye, but more importantly, to eliminate lesions that cannot be seen by the naked eye, which is very useful for preventing recurrence. Iodine abstinence for four weeks and discontinuation of thyroxine tablets for three weeks are required prior to treating metastases. Step 4: Thyroxine Tablets (Eugenol) Suppression Therapy Thyroid suppression therapy is different from replacement therapy for hypothyroidism, which requires a certain level of TSH to be achieved. In the case of low-risk patients, it is enough to control TSH normally; in the case of high-risk patients, it is necessary to control TSH below 0.1. Thyroxine tablet suppressive therapy is lifelong.