Introduction. Thyroid Hurthle cell carcinoma (HCC) is a rare disease only 3% with high risk of invasion, metastasis and poor prognosis. Case report. The patient, 53 years old, went to the Oncology Institute with complaints of local discomfort when swallowing and dyspnea. Ultrasound examination detects large thyroid nodules which suddenly increased. Total thyroidectomy was performed. Macroscopic: Thyroid gland - irregular shape: right lobe 6x4x3.5 cm, lobulated appearance, gray-pink, elastic. Left lobe14x6x4.5 cm with the same appearance. Histopathological: both lobes are diffusely infiltrated by Hurtle cell (oncocytic) follicular carcinoma, partially encapsulated, angioinvasive, with trabecular pattern, with tumor invasion in the tumor's capsule, with infiltration of the thyroid capsule and adjacent muscle tissue. Immunohistochemically, tumor cells are negative for chromogranin A and calcitonin. After 3 months, Radiotherapy treatment was performed at the thyroid lodge, bilateral cervical and supraclavicular nodes, superior-anterior mediastinum with DS-2Gy DT-40Gy. Over 3 years, the laterocervical lymph nodes on the left enlarge. Radical excision of cervical lymph nodes was performed. Histopathological: In 4 out of 6 lymph nodes metastases of thyroid follicular carcinoma from poorly differentiated Hurtle cells (oncocytic), with immunophenotype: PCK (+), CK7 (+), TTF1 (+), Thyroglobulin (-), INSM1 (-), mammoglobin (-). Conclusion. Currently, the diagnosis of Follicular Carcinoma with Hurtle cells, only by cytomorphology is difficult. Therefore, histopathology with immunohistochemistry is mandatory to confirm the diagnosis and ensure appropriate management.