Bone metastases due to thyroid cancer, which cause debilitating pain, spinal cord compression, and pathologic fractures are lesions mostly with poor prognosis. Whole body computerized tomography and magnetic resonance gained prominence in recent years in the imaging of these lesions which may present in various locations including the axial spine. Anti-resorptive drugs such as bisphosphonates and denosumab have been thought to reduce the incidence of skeletal related events. Only two thirds of patients are sensitive to radioactive iodine ablation therapy, and the full response rate is 46%. After the approval of sorafenib for the treatment of metastatic thyroid cancer, thyrosine kinase inhibitors also gained popularity in the treatment of bone lesions. Percutaneous methods such as vertebroplasty and cementoplasty can be used in the surgical treatment. In patients with spinal lesions, NOMS Framework (neurological, oncological, mechanical, systemic) may help with the selection of the candidates which are better suited for surgical decompression. Angioembolization is recommended prior to surgery due to the hypervascular nature of these tumors. In patients with no other metastases, it has been shown that treating bone lesions as primary malignant bone tumors improves the survival and functional outcome scores.