This is a case of a 78 years old female presented with a 7 years history of gradually enlarging anterior neck mass on the left. 1 year prior to admission, mass was noted to have skin involvement with associated hoarseness. No dysphagia noted. On past medical history, the patient underwent subtotal thyroidectomy last 2002. On physical examination, there is a 10x 7cm mass firm fixed non-tender anterior neck mass with skin ulceration and surrounding erythema. Work up was done and revealed Papillary thyroid carcinoma on FNA. CT scan of the Neck showed an enhancing pedunculated mass at the left of the infrahyoid neck measuring 9 x 6.4cm with laryngeal involvement. Cervical lymph nodes were also noted. Patient was scheduled for OR after cardiopulmonary and endocrinology clearance was given. Patient underwent tracheostomy, Modified Radical Neck Dissection, Completion Thyroidectomy with enbloc Laryngectomy. Wound defect was reconstructed using a Pectoralis Major Flap. Post-operative course was unremarkable and the patient was discharged stable.