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Cervical lymph nodes can indicate various inflammatory or cancerous conditions. Ectopic thyroid carcinoma, particularly papillary carcinoma, can be found in resected lymph nodes even without clinical thyroid abnormalities, known as hidden (incidental) metastasis. We present the case of a 42-year-old woman with a 5 cm thyroid nodule and associated symptoms. Ultrasound and biopsy confirmed a multinodular goiter and an incidental metastatic papillary thyroid carcinoma (PTC) in the right cervical lymph node. A total thyroidectomy and lymph node exploration revealed PTC metastasis. Treatment included 100 mCi ablation, resulting in a complete response. This case emphasizes the need for careful evaluation and precise treatment planning for patients with PTC to avoid misdiagnosis., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Specialties Hospital "Dr. Antonio Fraga Mouret", La Raza National Medical Center of the Mexican Institute of Social Security (IMSS) issued approval 37-23. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hernández-Utrera et al.)