Primary squamous cell carcinoma (PSCC) arising from the thyroid gland is an unusual entity with a lower incidence among all thyroid malignancies. It has an extremely aggressive phase and an overall poor prognosis. PSCC of the thyroid is commonly treated with surgical excision, followed by additional resection for tumor recurrence. We describe here a rare case report of a male patient who had complained of neck swelling and dysphagia for 6 months. Conventional ultrasonography showed a huge suspicious mass characterized as being heterogeneous hypoechoic, microlobulating, and solid with blurred margins and microcalcifications and with a seemingly defective thyroid capsule; color Doppler flow imaging showed the patient had little blood at the margins, and power Doppler examination was noted with patterns II of blood blow. Real-time ultrasound elasticity was performed to improve accuracy in predicting the malignancy of the mass, and ultimately, the carcinoma was definitely diagnosed as PSCC with the ultrasound-guided core needle biopsy. When pathologist conducted a comprehensive review of the specimens, immunohistochemistry showed nests of tumor cells showing positive immune-reactivity for P63, CK19 (+), and CK5/6 (+) and negative for TTF-1 and thyroglobuin. Herein, we report the findings of conventional ultrasonography and real-time ultrasound elastography of a rare case of PSCC.