Metastatic carcinoma to the sinonasal tract is rare, by papillary thyroid cancer even rarer. We describe a 44-year old Hispanic woman with follicular variant papillary thyroid carcinoma treated with total thyroidectomy and post-surgery I 131 ablation. Post therapy, two consecutive body scans were negative and thyroglobulin level was less than 5 ng/ml. A year later, she presented with history of urinary retention and lower extremity weakness. A myelogram revealed block at T1-T2. Patient underwent laminectomy followed by external radiation. Pathology revealed metastatic follicular variant of papillary thyroid carcinoma. Total body scan post-surgery was negative, and the thyroglobulin level was 5 ng/ml. Patient was maintained on thyroxine suppression therapy. Two years later, patient started complaining of headaches and double vision. Magnetic resonance imaging (MRI) was done and revealed a soft tissue mass in the sphenoid sinus, eroding the basi-sphenoid and extending into the nasopharynx. Biopsy was positive for metastatic papillary thyroid cancer, follicular variant. Pituitary function testing revealed TSH 0.1 mIU/ml, free T4 level 1.2 mIU/ml. AM cortisol 5.3 mcg/dl, prolactin 182 ng/ml, ACTH 12 pg/ml, FSH 11.5 mIU/ml, LH 4.0 mIU/ml, and Estradiol 20 pg/ml.Metastasis to the sphenoid sinus is rare from any tumour, and from papillary thyroid cancer is extremely rare. An extensive world literature review revealed only 4 cases of papillary thyroid carcinoma with spread to sphenoid sinus region. Of 12 case reports of thyroid carcinoma with spread to the sphenoid sinus, 6 were follicular thyroid carcinoma. Generally, total body scan negative with low stimulated thyroglobulin is an excellent prognostic sign. Our patient demonstrates that we need to remain vigilant for the unusual tumour especially when the initial presentation showed a large lesion.