Distant metastasis was associated with larger tumor size (p = 0.001), aggressive histologic subtype (p = 0.003), advanced pT stage (p < 0.001), extrathyroidal extension (p = 0.001), lymph node metastasis (p < 0.001), lateral lymph node metastasis (p < 0.001) and the TERT promoter mutation (p < 0.001). The gene discussed is TERT; the disease is metastatic malignant neoplasm in the lymph nodes.