We presented a 50-year-old female patient with a large painful mass in the right humerus for 5 years, presenting with swelling of the right shoulder with limited mobility. PET/CT with 18F-fluorodeoxyglucose (18F-FDG) showed a large mass in the right humerus (130 x 115 x 174 mm), bilateral lung lesions, and enlarged lymph nodes in the right supraclavicular fossa ( Figure 1 ). Right humerus lesion biopsy was carried, and the histopathology of the specimen displayed fistular and sieve distribution with obvious nuclear heterogeneity ( Figure 2A ). The immunohistochemical stains were positive for thyroid transcription factor (TTF-1), thyroglobulin (TG), cytokeratin (CK) pan, and CK7 and negative for hepatocyte (HPC), alpha fetoprotein (AFP), Syn, CgA, special AT-rich sequence-binding protein 2 (SATB2), calcitonin, P53, Napsin A, estrogen receptor (ER), progesterone receptor (PR), and cadual type homeobox gene 2 (CDX2), which indicates that the lesion originated from the thyroid follicular epithelial cells and not from the liver, breast, colon, lung, or thyroid parafollicular cells; Ki67 proliferation index was about 10% ( Figures 2B-F ). Then, the thyroid ultrasonography was carried and revealed a hypo-echoic solid nodule with an irregular taller-than-wide shape (4.7 x 3.7 x 5.3 mm) in the upper of left thyroid lobe; this thyroid nodule has nine points and classified as ACR Thyroid Imaging, Reporting and Data System (TI-RADS). The thyroid nodule showed uneven iso-enhancement on the contrast-enhanced ultrasonography (CEUS), which indicates that the enhancement of thyroid nodule was equal to that of the surrounding tissue. The enlarged lymph nodes with the absence of fatty hilum were displayed in the contralateral right IV compartment of cervical lymph nodes ( Figure 3 ). The total thyroidectomy and right lateral cervical lymph node dissection were undertaken; the histopathology confirmed the diagnosis of PTMC with contralateral cervical lymph node metastasis (2/18), indicating two lymph nodes involved in the right IV compartment of cervical lymph nodes, and the total number of the right lateral cervical lymph nodes was 18 ( Figure 4 ). Interestingly, the patients had no central cervical lymph node metastasis (0/7), and the BRAFV600E mutation of the PTMC was wild type. According to the eighth edition of the American Joint Committee on Cancer/Tumor Lymph Node Metastasis (TNM) staging system, the patient was in TNM stage IVb (T, N1, of M1).