Abstract: Recombinant human thyroid-stimulating hormone (rhTSH) has demonstrated favorable clinical value in postoperative thyroid remnant ablation for differentiated thyroid cancer (DTC), significantly improving the preoperative patient experience compared with the conventional thyroid hormone withdrawal (THW) regimen. However, domestic and international guidelines have not yet established unified standards for the off-label application of rhTSH in ¹³¹I ablation for unresectable metastatic lesions of DTC (referred to as lesion ablation). The authors review the differences between rhTSH and THW regarding thyroid-stimulating hormone dynamics, radioiodine uptake parameters of lesions, therapeutic efficacy on metastatic lesions, patient prognosis, and adverse events, aiming to explore the clinical value of rhTSH in lesion ablation. Current clinical evidence indicates that both strategies yield comparable efficacy in the treatment of measurable metastatic lesions following multiple rounds of radioactive iodine therapy.