Conclusion:
In summary, we present an unusual case of PTC presenting as a cerebellar metastasis, without an identifiable focus of PTC within the thyroid gland, but rather an extrathyroidal deposit in a left level VI node. An incidental focus of microMTC was present in the thyroidectomy specimen. Management consisted of total thyroidectomy, resection and radiosurgery of the cerebellar metastasis, and radioactive iodine ablation. There is evidence of new skeletal lesions on follow-up FDG-PET scan suggestive of RAI-refractory disease. This case highlights the rarity of distant metastases in PTC and in particular brain metastasis, which confers poorer prognosis. Such patients may exhibit genetic profiling that is distinct from PTC without distant metastasis. Finally, the presence of microMTC was an unexpected finding. The clinical relevance and risk stratification of incidental microMTC in this setting requires further studies