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Follicular thyroid carcinoma with metastasis rarely manifests as spinal cord compression without any previous symptoms of its malignancy. This report describes a 64-year-old man with follicular thyroid carcinoma who presented initially with left arm motor weakness. Magnetic resonance images demonstrated severe cervical cord compression by a mass with destruction of C4 vertebra. Corpectomy of C4 and anterior interbody fusion was carried out. Histopathological study revealed a metastatic follicular carcinoma of the thyroid. We present our case, especially focused of its possible pathophysiology, with review of pertinent literatures.