Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) of the thyroid gland is a very rare carcinoma. We herein report on a case of SMECE with metastasis to bilateral lateral neck nodes, esophagus, and trachea. A 72-year-old woman presented with a neck mass found incidentally during a medical check-up. She had a history of cerebral stroke without sequelae 20 years ago and was taking aspirin regularly. The neck mass was confirmed as papillary thyroid carcinoma by fine needle aspiration biopsy. The patient underwent bilateral total thyroidectomy with central compartment and bilateral compartment lateral neck dissection. The right recurrent laryngeal nerve was sacrificed due to tumor invasion. The trachea wall and esophagus were also invaded by the cancer. Histologically, the tumor showed dense fibrohyaline stroma and a goblet cell, nested islands of squamoid cells, and marked stromal eosinophilia with perineural invasion and lymphovascular invasion, confirming the diagnosis of SMECE. After radiation therapy for three months, distant metastasis to the liver, lung, and bone were found on PET-CT. This case appears to be more aggressive than previously reported cases.