Management of radio-iodine uptake negative Metastatic Papillary thyroid cancer

64 yo caucasian female presents to medical oncology clinic for a second opinion regarding management of her progressive metastatic papillary thyroid cancer. She was diagnosed at the age of 40 yrs with a 3.5cm left thyroid nodule which on FNA showed PTC. She was treated with total thyroidectomy (showed extra thyroidal extension) and central lymph node dissection(LN neg). She was treated with RAI followed by TSH suppression to 0.1-0.5 range. She subsequently developed pulmonary and bone metastasis about 10 yrs ago and was retreated with RAI and TSH suppression to <0.1. She got treated 3 years ago with RAI for a third time for progression in her lungs. Patient now has increasing shortness of breath and dyspnea on exertion. Iodine uptake study shows no iodine uptake. You confirm that she has not received any contrasted CT studies. d dimer neg. PET/CT shows evidence of progressive metastatic disease in lungs and bone.

What is the best treatment option for this patient at this time?