Abstract: Differentiated thyroid carcinoma (DTC) includes papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), and Radioactive Iodine (RAI) therapy serves as the cornerstone of postoperative management for this malignancy. Excellent response (ER) is a key indicator for evaluating the therapeutic response of DTC, which indicates the absence of recurrence or residual disease in patients, correlating with favorable prognosis. However, substantial interindividual variability exists in patients’ responses to ¹³¹I therapy: some patients fail to achieve ER, and a subset even progress to radioactive iodine-refractory disease. Identifying the key factors influencing ER is critical for optimizing individualized treatment strategies. Therefore, this article systematically reviews recent research on the predictive factors associated with ER attainment in DTC patients following ¹³¹I therapy, covering thyroglobulin (Tg) and its related indicators, tumor pathological features, treatment protocol, comorbidities, and other relevant factors. The aim is to provide a theoretical basis for precise clinical management.