Papillary thyroid microcarcinoma is defined as a papillary thyroid cancer measuring <10 mm in its largest diameter. We present the scan images of a 36-year-old white woman, with the diagnosis of an incidental papillary thyroid microcarcinoma of 2 mm developed from lymphatic thyroiditis, associated with an invasive papillary thyroid carcinoma with lymph node metastases occurring in an ectopic thyroid gland in the mediastinum. This case underlines the need to evaluate individually and carefully every patient with papillary thyroid microcarcinoma, to accurately plan a therapeutic strategy.