A 56-year-old woman with a papillary thyroid carcinoma with TERT+BRAF mutations in left thyroid lobe. Transverse (A) ultrasonographic image shows a 3.0-cm solid mass with spiculated margin, irregular shape, hypoechogenicity, non-parallel orientation, and microcalcifications. Transverse (B) ultrasonographic image shows an enlarged lymph node with increased cortical echogenicity and cystic changes in left level IV. The main mass was classified as K-TIRADS category 5 and the level IV lymph node was considered metastatic. After surgery, level IV lymph nodes were confirmed as metastases and TNM stage was classified as IV. Bilateral lung metastases and operative bed recurrences were diagnosed 4.4 years after surgery.