The clinical significance and provenance of incidentally-discovered bland thyroid follicles in lateral neck lymph nodes has been a subject of debate within the medical community for several generations, namely, (1) whether benign non-neoplastic thyroid follicles may occur in lateral neck lymph nodes, (2) whether the presence of any thyroid tissue in a lateral neck lymph node by definition represents metastatic carcinoma, and (3) what is the most appropriate course of thyroid evaluation/treatment for these patients. This review evaluates two populations reported in the literature: patients with bland thyroid follicles (BTFs) versus those with morphologically diagnostic papillary thyroid carcinoma (PTC), all found in lateral cervical lymph nodes undergoing neck dissection for non-thyroid disease. Two of 45 BTF patients were found to have primary thyroid carcinoma (4% of total BTF, 5% of BTF patients who underwent thyroid evaluation). In contrast, 54 of 102 PTC patients had primary thyroid carcinoma (53% of total PTC, 77% of PTC patients who underwent thyroid evaluation). In both populations, no patient had progression or recurrence of thyroid disease. Approximately one-third of BTF patients died of non-thyroid related disease. Additionally, few studies evaluating the molecular underpinnings demonstrated that intranodal BTFs are BRAF p.V600E negative and PTCs are more frequently positive. In conclusion, patients with BTFs may be managed conservatively with ultrasonographic evaluation of the thyroid and consideration for surgery only in the setting of a suspicious exam. Patients with morphologic PTC are at higher risk for intrathyroidal carcinoma and stronger consideration should be given to thyroidectomy. Good prognosis of thyroid disease is expected in all patients. The primary drivers for patient prognosis are the diseases that prompted initial neck dissection.