Thyroid tissue in an ectopic location is rare, 1 in 100,000 to 300,000 persons, and usually in the lateral neck. Median ectopic thyroid tissue is even more unusual, with the vast majority of cases being lingual thyroid tissue. We present a case of carcinoma arising in median, nonlingual ectopic thyroid tissue along with an analysis of the literature to determine the most appropriate management of the orthotopic thyroid gland.