Abstract: This paper reports a case of subacute liver failure caused by sorafenib treatment of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC), and comprehensively analyzes the characteristics of the disease from clinical symptoms, laboratory examinations, imaging examinations, histopathological examination results as well as the patient's clinical treatment and outcome. Through literature review, the authors deepen the understanding of the characteristics of the disease, the efficacy and adverse reactions of sorafenib in the treatment of advanced thyroid cancer. This paper aims to remind clinicians that when encountering similar cases, they should not only pay attention to the efficacy of sorafenib treatment, but also improve the clinical awareness and management of adverse reactions related to the application of targeted drug therapy in RAIR-DTC, and ultimately improve the efficacy and safety of targeted therapy.