Caroline S. Kim, MD, examines the oncogenetic profile, classification and pre- and post-operative management of medullary thyroid cancer (MTC), among the rarest of the thyroid cancers. Topics discussed include the management of recurrence and metastases; the time to intervene; the tyrosine kinase inhibitors vandetanib and cabozantinib in metastatic and progressive MTC, respectively; and the hormonal manifestations of MTC.