Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy often presenting with multifocal solid thyroid lesions or cystic lymph nodes and has a good prognosis. A large solid cystic appearance of the primary is a rare entity that is associated with locally advanced disease. Extrathyroidal extension (ETE) is one of the few risk factors for local recurrence. We present a case of a 58-year-old lady who had presented with a cystic large thyroid tumor, papillary cancer on cytology, solid cystic on imaging with laryngeal tract invasion, and pharyngeal involvement at the surgery. Adequate preoperative planning and intraoperative measures are essential to achieve a good outcome.