BACKGROUND AND OBJECTIVE: Thyroid carcinomas thymus-like differentiation (CASTLE) are rare. The aim of this paper is to address a valid diagnostic and therapeutic protocol for these tumours using three exemplary cases and the previously published literature, METHODS: The routine use of Magnetic Resonance Imaging (MRI) in all cases of unclear thyroid fine needle aspiration cytology (FNAC) or in cases of multiple neck masses. RESULTS: Three cases of thyroid CASTLE tumours, finally confirmed by histology, are evaluated. All three patients remain in good conditions after an aggressive surgical approach followed by radiotherapy CONCLUSIONS: MRI should be routinely used in cases of unclear FNAC or multiple neck masses, Surgery and radiotherapy are effective to manage thyroid CASTLE tumours.