A total thyroidectomy with limited neck dissection and with intraoperative nerve monitoring was completed. In addition, excision of the left supraclavicular mass was also performed. The specimen was sent off to pathology, which returned as anaplastic sarcomatoid carcinoma of the thyroid. The procedure was complicated by the intricate growth of the tumor around the left carotid artery. After several hours, most of the tumor was excised, however, some microscopic tumor still remained.