Recently, a patient with diffuse sclerosing variant of papillary thyroid carcinoma (DSPTC) was admitted to the Department of Thyroid Surgery of our hospital. The patient was a 40-year-old male who was admitted to our endocrinology department with “wasting, excessive sweating and weakness for 3 months” and was treated with “hyperthyroidism”. He was treated with hyperthyroidism. Ultrasound and ultrasound-guided fine-needle aspiration cytology (FNA) revealed suspicion of malignancy and was referred to our department for surgical treatment. The patient recovered well and was discharged from the hospital. DSPTC accounts for 0.7%-6% of PTC and has a relatively young age of onset, which is often seen in children with thyroid cancer. The typical ultrasound image of DSPTC is a “blizzard” of calcified dots, and ultrasound-guided FNA can be helpful for diagnosis. In this case, the patient was treated as “hyperthyroidism” upon admission, and was found to have positive ATPO and negative ATG and TRAb. Once the rapid pathology suggested DSPTC, total thyroidectomy + central group lymph node dissection was performed, and then left functional neck lymph node dissection was added according to the lymph node metastasis in the lateral region. DSPTC has a poorer prognosis than ordinary PTC, and is often associated with cervical lymph node metastases, and pulmonary metastases are not uncommon. Multifactorial analysis of DSPTC itself is a high risk factor for recurrence. Post-surgical iodine release therapy: sodium iodine transporter (NIS) expression is less in DSPTC, and the expression of NIS in PTC vs. DSPTC was reported as (228/312, 73.1% vs. 12/30, 40%), so DSPTC requires higher cumulative dose to improve the prognosis.2 At follow-up, note that TG may be affected by positive ATG and cannot be used as a judgment indicator. For cases similar to Hashimoto’s thyroiditis, ultrasound and FNA can help in the differential diagnosis; the typical sonographic feature of ultrasound is the presence of “blizzard”-like calcified dots; when FNA is performed, the thyroid tissue is directly punctured without nodules. 2.If intraoperative rapid suggestion of DSPTC, total thyroidectomy + cervical lymph node dissection should be performed according to the situation. 3.Postoperative radioactive iodine treatment with increased cumulative dose. 4, TG may not be measured at follow-up due to positive ATG, and a negative ATG may also be a sign of cure.