Medullary thyroid carcinoma originates from the thyroid parafollicular cells and accounts for 3–10% of all thyroid malignancies.A 34year old male patient presented with hoarseness of voice. Cervical lymphadenopathy is present without any palpable thyroid mass. Plain & CECT showed multiple heterogeneous enhancing lesions noted in both lobes of thyroid , and isthmus.FNAC of thyroid mass and neck nodes revealed clusters of plasmacytoid cells and few binucleate cells. Round to elongated nuclei with granular chromatin and inconspicuous nucleoli in the tumor cells with occasional pseudo–inclusions suggestive of MTC thyroid. FNAC from bilateral nodes revealed necrotic & amyloid material