How would you approach a locally advanced, radioiodine naive papillary thyroid carcinoma not amenable to a non-morbid surgery?

In certain cases there may a be a potential benefit. We have an 87 year old male with significant co-morbidities that prevented him from being a surgical candidate. Stage 4 papillary thyroid cancer with 1.7 cm right thyroid primary, 2.5 cm RML lung mass and 5 cm right cervical neck mass that was ver...

RAI prior to total thyroidectomy is of no benefit and may be toxic. Pre-op TKI should not be considered outside of clinical trial. There are some successful case reports of this approach in literature but I am not aware of any trials looking into this. I am unclear as to why this tumor is unresectab...

There is no proven role for preoperative RAI in patients with unresectable iodine-avid well-differentiated thyroid cancer. The penetration of the isotope is minimal and the high likelihood of glandular edema resulting from the treatment would be morbid. I have no experience with neoadjuvant systemic...