ObjectiveTo summarize the experiences and lessons of diagnosis and treatment of follicular thyroid carcinoma (FTC) with lymph node and lung metastases.MethodThe clinicopathologic data of a case of FTC with metastases of cervical, mediastinum, axillary lymph nodes, and bilateral lungs were analyzed retrospectively.ResultsThe case was a 39 years old male patient, who was diagnosed with the right FTC with multiple metastases. The total thyroidectomy+lymph node dissection in bilateral central and bilateral neck regions+lymph node dissection in the left axillary was intended to perform in the Department of Thyroid and Parathyroid Surgery of the West China Hospital. During the operation, the upper mediastinal lymph node fusion was found, and the tumor was tightly adhered with the recurrent laryngeal nerve, the signal was lost after the adhesion separation. In the right central area, the enlarged lymph nodes penetrated down into the upper mediastinum. More enlarged lymph nodes extended upward into the subclavian area in the left armpit. Considering a longer operation time and about 2 000 mL bleeding amount, the mediastinal and left neck operation was decided to perform in the second stage after consulting with the thoracic surgeon. At more than 6 months after the operation, the patient underwent the mediastinal lymph node dissection+superior vena cava (SVC) restoration+metastatic tumor resection+SVC shunt operation in the Department of Thoracic Surgery of the West China Hospital. The operation was successful, without hypocalcemia, dyspnea, and other complications. At 8 months after the operation, the third operation was performed in the Department of Thyroid and Parathyroid Surgery of the West China Hospital, that was, total residual thyroidectomy+left central and left cervical lymph node dissection+left axillary lymph node dissection (level Ⅱ–Ⅲ). The postoperative pronounce didn’t change, without hypocalcemia and other complications. Three times of iodine ablation therapy were performed in the West China Hospital. The occupy didn’t be found by the neck ultrasound and the pulmonary metastasis was stable by the CT during the regular follow-up.ConclusionsAccording to this case, neck surgery with SVC syndrome, SVC syndrome should be treated preferentially. For patient with complicated condition, unconventional approaches could be selected according to actual condition of patient, and staging surgery might be a good choice.