Thyroglossal duct cyst (TGDC) is the most common congenital neck mass with the vast majority being diagnosed in childhood. TGDC result from incomplete closure of the thyroglossal duct between foramen caecum and the thyroid typically resulting in a midline neck mass that moves on swallowing and tongue protrusion. Malignancy arising from a TGDC is rare occurring in less than 1% of cases. Papillary thyroid carcinoma (PTC) is the most common of these TGDC malignancy. We report the case of a 16 year old female with PTC arising from a TGDC. Presenting with a 2 month history of an asymptomatic anterior neck mass. An ultrasound showed a mixed cystic and solid 50 x 30 x 27mm lesion, to the right of midline, in close proximity to the hyoid bone. The patient underwent a Modified Sistrunk’s procedure. Histopathology returned as papillary thyroid carcinoma, classic variant that was BRAF positive on immunohistochemistry and completely excised. Following multidisciplinary team discussion, the patient was commenced on a surveillance pathway with 6 monthly imaging. Malignancy arising from a thyroglossal duct cyst is an uncommon pathology. Given the rarity of this pathology, there remains discordance in the way it is managed, in particular, the extent of surgical resection and need for adjuvant therapy such as radioactive iodine. This is a rare case of papillary thyroid carcinoma arising from a thyroglossal duct cyst managed with modified Sistrunk’s procedure and radiological surveillance.