A woman was diagnosed at age 62 with follicular thyroid carcinoma. The patient presented with a fracture based on a metastasis in the left os pubis which was treated by local radiotherapy. Total thyroidectomy was performed, followed by Iodine and adequate suppression therapy with levothyroxine. Serum thyroglobulin levels remained maximally positive (>1000 ng/ml) despite further Iodine treatment, with a total dose of 750mCi. Two years later diffuse lung metastases were found, and new bone metastases at vertebrae L2, T7 and 8, and left humerus were detected; all were treated with local radiotherapy. Five years after initial diagnosis the patient noticed a painless slowly growing mass on the skull. CT scan confi rmed a soft tissue bulge of 3,7 x 6,2 x 5,9 cm with deformation of the underlying frontal bone and impression on the dura. However, there was no cerebral compression and neurologic symptoms remained absent. The patient wished to postpone biopsy or further local radiotherapy. She died 2 years later from respiratory insuffi ciency based on pneumonia with sepsis.