Papillary thyroid cancer (PTC) often leads to cervical lymph node metastasis, occurring in 50–70% of cases. This high prevalence can sometimes cause clinicians to overlook other potential causes of cervical lymphadenopathy, especially in regions where tuberculosis (TB) is common. Distinguishing between these conditions can be challenging as they appear similar on ultrasound and cytology. However, examination of paraffin-embedded sections is the most effective way to differentiate between the two. We present a case series of three interesting patients where differentiation between the two conditions posed a diagnostic challenge. In two patients, the diagnosis was made after surgery, while in one patient, the diagnosis was made before surgery, preventing the patient from undergoing an unnecessary procedure.