In the past decade, there have been a significant number of new therapeutic alternatives approved by the US Food and Drug Administration for progressive locally advanced and metastatic thyroid cancers of follicular cell origin that are refractory to standard therapy (surgical removal, thyroid hormone for thyroid-stimulating hormone suppression, and radioactive iodine ablation).1-6 These new agents are in 2 categories of compounds: angiogenesis inhibitors (cabozantinib, lenvatinib, and sorafenib) and driver mutation-targeting agents (vandetanib, pralsetinib, trametinib, selpercatinib, and dabrafenib). The approval of the angiogenesis inhibitors was based on level I evidence showing prolonged progression-free survival (PFS) compared with placebo agents as the primary outcome measure.1-3