Background: Being aware of the unusual or rare location of thyroid metastases helps
in early diagnosis and proper patient management. Rare metastases (RM) can be
missed resulting in diagnostic pitfalls and delayed treatment. The use of single-photon
emission computed tomography/computed tomography (SPECT/CT) imaging in the
follow-up of differentiated thyroid cancer (DTC) patients provides precise anatomical
localization and characterization of RM that may be missed or misinterpreted in planar
whole body iodine-131 (WBI) scan. There is a lack of knowledge about dealing with
such patients, the treatment they should receive, and therapy response due to the rarity
of such cases. In this work, we reported these rare cases increasing awareness about
them and their methods of treatment with response to therapy and evaluated the
added value of SPECT/CT imaging in changing patients’ management.