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Since the FDA approved sorafenib use for thyroid cancer, administration of this medicine to thyroid-cancer patients had steadily increased. However, an appropriate starting dose for this treatment has not been established, which is problematic because the sorafenib discontinuation rate due to toxicity is higher among thyroid cancer patients than among patients with other solid tumors. We recently treated a papillary thyroid cancer patient who experienced a dramatic improvement after being treated with a 400-mg starting dose of sorafenib. Herein, we describe this case and discuss its implications for an appropriate sorafenib starting dose for thyroid cancer.