Apart from recent advancements in chemotherapy agents, the potential role of metabolic interventions, including the use of metformin, ketogenic diet, and high-dose vitamin C in the management of advanced cancers have been investigated as a less toxic co-adjuvant therapies. The role of vitamin C has been of interest again after a preclinical mice study showed that high-dose vitamin C is selectively lethal to KRAS and BRAF mutant colorectal cancer cells by targeting the glutathione pathway. Similarly, alteration of cellular metabolism by low-carbohydrate ketogenic diets can be an important therapeutic strategy to selectively kill cancer cells that mainly survive on glycolysis. In conclusion, in addition to concurrent chemotherapy options, these metabolic interventions may have a great potential as co-adjuvant therapy in the management of aDTC. The incidence of DTC has grown in recent years due to availability of advanced and sensitive diagnostic tests, which has led to increased detection of micro-carcinomas. Despite low mortality, this disease has been treated aggressively for fear of more advanced disease and lack of effective tools for risk stratification. These aggressive treatments include high doses of radio-active iodine multiple times that have several side effects on other types of cells and chemotherapy that increase survival but decrease quality of life.
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