Background Renal cell carcinoma is known for its unpredictability and long malignant potential. Common metastatic sites of renal cell carcinoma are the lungs, lymph nodes, bones and liver. Concurrent thyroid metastasis of clear cell carcinoma is uncommon. Although no consensus surveillance protocol exists post nephrectomy, none go past 10 years. Case Report We report a case of a 80-year-old male patient with a past history of clear cell renal carcinoma for which he underwent a left nephrectomy 18 years prior. The patient presented to the emergency department with a 2 week history of haemoptysis, for which he was investigated with a computed tomography scan of his chest. This revealed a partially imaged bulky heterogeneous thyroid mass causes significant narrowing of the upper thoracic trachea. Flexible nasendoscopy was performed after transfer to a tertiary facility which confirmed tracheal invasion of this thyroid mass. This mass presented a difficult diagnostic journey with initial fine needle aspirate and microlaryngoscopy biopsy samples suggesting different, benign causes. Eventually open biopsy was performed and histopathological specimen compared with that of the initial renal cell carcinoma and metastatic disease was confirmed. Conclusion In all patients with a difficult to diagnose thyroid mass and a past or present history of RCC (no matter how distant), suspicion should remain for a metastatic lesion.