Cervical lymph node metastasis of papillary carcinoma of the thyroid gland is common whereas retropharyngeal lymph node metastasis is rare. Strategies for treating retropharyngeal lymph node metastasis must be considered based on the balance between the radicality of the disease and the quality of life after treatment.? Here, we report a case of papillary carcinoma with bilateral retropharyngeal lymph node metastases in a 66-year-old male. This patient presented with lumps in the neck. Computed tomography showed thyroid cancer with multiple cervical lymph node and bilateral retropharyngeal lymph node metastases. Hemithyroidectomy with neck dissection was performed and the retropharyngeal lymph nodes were successfully dissected only by a cervical approach without any severe complications.? We discuss here the problems encountered in the diagnosis and treatment of retropharyngeal lymph node metastasis of papillary carcinoma of the thyroid gland. The possibility of metastasis to this region should be considered in the treatment of thyroid carcinoma with multiple cervical lymph node metastases. The appropriate choice of surgical approach is crucial to improving the post-operative quality of life of these patients.