Various factors leading to unexpected false-positive 131I uptake have been extensively studied in patients with differentiated thyroid carcinoma. In this case, we present a patient who underwent achalasia surgery and subsequently exhibited abnormal 131I uptake on SPECT/CT imaging. The patient was a known case of papillary thyroid carcinoma that suggested to 131I therapy. 131I SPECT/CT showed linear increased activity in the distended esophagus.