Local recurrence or metastasis can occur in residual thyroid tissue, soft tissue of the neck and lymph nodes, and distant metastases can occur in the lungs, bones, brain and bone marrow. The treatment options for recurrent or metastatic lesions are, in order of preference, surgical resection (for those with potential surgical cure), 131I therapy (for those with iodine uptake), external radiation therapy, observation with TSH suppression (for those with no or slow tumor progression and asymptomatic, no significant regional involvement such as the central nervous system), chemotherapy and new targeted drug therapy, and approved clinical trials of drugs (for those with rapidly progressive, difficult to treat disease). The final treatment regimen must take into account the patient’s needs and the patient’s needs in the clinical trials of approved drugs (refractory DTC patients with rapidly progressive disease). The final treatment plan must take into account the patient’s general status, co-morbidities and previous response to therapy. Patients with fully cleared thyroid DTC have persistently elevated serum Tg levels (>10ng/ml) at follow-up, but no lesions are detected on imaging. For such patients, 131I therapy of 3.7-7.4 GBq (100-200 mCi) can be given empirically; if DTC lesions or serum Tg levels are reduced after treatment by Dx-WBS, 131I therapy can be repeated; otherwise, 131I therapy should be discontinued and TSH suppression therapy should be the mainstay.