Papillary Ca thyroid usually presents as :

"Most patients are euthyroid and present with a slow-growing painless mass in the neck Dysphagia, dyspnea, & dysphonia are usually associated with locally advanced invasive disease. Lymph node metastases are common, especially in children and young adults, and may be the presenting complaint so-called 'lateral aberrant thyroid', almost always denotes a cervical lymph node that has been invaded by metastatic cancer. Diagnosis is established by FNAB of the thyroid mass or lymph node" - Schwartz Surgery More about Papillary Ca thyriod PTC is the most common type of thyroid carcinoma More common in females with a female : male ratio of 2 : 1. Mean age at presentation is 30 to 40 years Most common presentation is a painless nodule in the neck or a cervical lymph node (lateral aberrant thyroid) Spread to the lymph nodes is common but blood-borne metastasis is unusual. Multiple foci may occur in the same lobe as the primary tumor or, less commonly in both lobes (this may be due to lymphatic spread in the rich intrathyroidal lymph plexus, or due to multicentric growth). Diagnosis is confirmed by FNA biopsy of the thyroid mass or lymph node.