This video presentation is about a 82 years old woman. Primary complaint is bleeding from neck mass and hoarseness. Neck CT showed that the right thyroid cancer have invaded to neck cutaneous, common carotid artery, internal jugular vein, and right sternocleidomastoid muscle. Chest CT showed small lung nodules. The cytology showed papillary thyroid cancer. The clinical staging was cT4bN1bM1, stage C. As the patient had a blood transfusion because of tumor bleeding at administration, we have performed the surgical removal and cutaneous reconstruction. We also discuss the surgical management in case of advanced thyroid cancer invaded with great neck vessels.