Primary osteosarcomas are rarely seen in areas other than bone, although they can occur in sites such as the thigh, anal region, hand, etc. We present a case of primary extraskeletal osteosarcoma of the thyroid, of which there are only 29 previous reported cases. Presentations and treatment options for this type of tumor vary. Through this case report, we discuss the similarities and differences of the patient’s presentation compared with other documented cases, imaging, the rationale behind treatment, and the current clinical course.