Introduction: Papillary thyroid carcinoma (PTC) is the most common neoplasm of the endocrine system and the least aggressive, representing between 70% and 80% of thyroid neoplasms. This is characterized by slow growth and a low risk of progression to metastasis. Brain Metastases (BM) associated with PTC occur with a incidence rate of 0.15%. Tyrosine kinase inhibitors (TKI) are a very promising alternative for managing these patients. Here is described the case of a patient with PTC with brain and lung metastases, her respective management and evolution. Clinical Case Report: A 64-year-old patient with a history of controlled hypothyroidism, who was recently diagnosed with high cell variant PTC, positive for BRAF V600E mutation. Neck CT revealed a thyroid mass extending to the superior mediastinum, with associated lung metastases. We started by suppressing TSH with levothyroxine. Brain MRI was done due to persistent and as safety precaution before starting thyrotropin alfa This showed multiple intra-parenchymal lesions compatible with BM. Patient received management with gamma Knife radiosurgery for BM and with lenvatinib 24mg day. The patient presented a decrease in tumor size by more than 50% in the neck, with disappearance of the majority of BM at 90 days. After 18 months of treatment, she was still alive. Discussion and Conclusion: PTC associated with BM has a very poor life expectancy, and there are not guidelines for its management and the treatment is based on case reports and expert opinions. Radiosurgery plus ITK combined therapy could provide better outcomes to these patients

Introduction: Brain metastases (BM) associated with papillary thyroid cancer (PTC) occur with an approximate frequency of 0.15% to 1.3% of PTC cases. There is little evidence regarding the treatment of this association (PTC and BM). A narrative review of the literature is presented. We assessed multiple treatment options and its effectiveness in this vulnerable population. Methods: The data were collected using the PubMed search engine and Google Scholar. There were selected all studies that included: << thyroid carcinoma >> << brain metastases >> << radiotherapy >> << surgery >> << iodine-131 >> << papillary carcinoma >> << differentiated carcinoma >>. Once the relevant works had been listed and compared, the main findings of each one were related and analyzed. Results: We found 15 studies between the years 1990 and 2019 that describe 187 patients with thyroid cancer and brain metastases; of which 138 presented PTC, and 62% (58/93) were women. The average age was 59 years. Patients who received multimodal treatment (association of 2 or more therapies; one of them, brain metastasis resection) had a longer survival, with an average of 54 months, compared to monotherapy. Discussion: Patients with PTC who also present BM require a multimodal therapy approach: when it is associated with brain metastasis resection, better results are evident; in contrast, when monotherapy is used, a limited performance is observed, with poor results. Conclusion: Patients with PTC who also present BM have better outcomes and higher survival rate with a multimodal therapy approach, including brain metastasis resection.