Objective: To investigate the effect of different treatment methods on the survival of patients with stage IV differentiated thyroid cancer (DTC). Methods: From January 2013 to June 2015, 90 patients with stage IV DTC in the Second Hospital of Shanxi Medical University were randomly divided into three groups according to the digital table, A, B and C group, with 30 cases in each group.The patients in A group were treated with surgery combined with ¹³¹I, and the patients in B group were treated with surgery combined with TSH inhibition, and the patients in C group were treated with operation combined with ¹³¹I + TSH inhibition.The therapeutic effect, postoperative quality of life score and short-term and long-term survival rate were evaluated. Results: After treatment, the levels of Tg in A group [(25.06±3.41)μg/L] and C group [(24.89±3.27)μg/L] were significantly lower than that in B group [(45.46±3.58)μg/L], and the levels of TSH in B group [(0.36±0.26)mU/L] and C group [(0.36±0.18)mU/L] were significantly lower than that in A group [(0.67±0.31)mU/L] (t=3.624, 3.337, 3.289, 3.667, all P<0.05). The success rates of nail clearance in A group and C group were 50.00%(15/30) and 56.67%(17/30), respectively, which were significantly higher than 33.33% (10/30) in B group (χ²=3.475, 4.967, all P<0.05). The postoperative quality of life (GQOLI-74) scores among the three groups had statistically significant differences (F=4.354, 5.216, 4.672, 5.197, all P<0.05). The 1-year (80.00%), 2-year (53.33%) and 3-year (33.33%) survival rates in C group were significantly higher than those in A group (43.33%, 36.67%, 20.00%) and B group (40.00%, 33.33%, 16.67%) (χ²=5.467, 3.661, 3.287, all P<0.05). Conclusion For patients with stage IV DTC, the combination of ¹³¹I+ TSH inhibitory regimen and operation regimen can significantly improve the therapeutic effect, improve the quality of life and prolong the survival time.