Thyroid carcinoma is a rare condition comprising 1% of all malignancies. Thyroid malignancies presenting with dyspnea and milliary metastasis are also rare. To manage and confirm lung metastasis in such cases beside evaluation of tuberculosis and other infections, considering iodine avidity and thyroglubolin levels are critical. In this situation, pulmonary fibrosis may be a severe side-effect and the indication for repeated courses of radioiodine therapy has to be decided thoroughly. Hyroglobulin level and the size of pulmonary nodules could be helpful for differentiating active lung metastasis from fibrosis. Here we report an Eighty years old man suffering from Papillary Thyroid Cancer with Follicular Variant and milliary lung metastasis at presentation.

Key words: Papillary carcinoma; Follicular   Variant; Thyroid nodule; Milliary lung metastasis  
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