Objective:

To make a report of an uncommon presentation.

Clinical case:

88-year-old female, emergency room admission, dyspnea and chest pain; tomography: right pleural effusion, pleural thickening, pulmonary nodulations; Pleural biopsy, metastasis of papillary thyroid carcinoma.

Discussion:

Metastasis has an incidence of less than 10%, however, it carries high mortality, the treatment of pleural effusion is controversial due to its unusual presentation in differentiated thyroid cancer.

Conclusion:

Pleural effusion as an initial symptom, has anecdotal reports in the universal literature, a correct approach allowed the diagnosis oriented to the underlying pathology.