Papillary carcinoma of the thyroid is a follicular type cancer, constituting the dominant histological type of all malignant neoplasms affecting the thyroid gland. His prognosis is generally favorable. The situations where this cancer becomes refractory to the action of radio-metabolic therapy are a real challenge for any clinician. The surgical resumption whenever possible, the use of chemotherapy with tyrosine kinase inhibiting agents, and external radiation therapy are the pillars of management in this type of cancer. We expose through three observations this issue and we discuss the approach toward this clinical situation.