Medullary thyroid carcinoma (MTC) is a rare tumor arising from parafollicular c-cells. It is responsible for a fair proportion of thyroid carcinoma-related deaths. The prognosis is less favorable than papillary thyroid carcinoma. Early diagnosis and prompt therapeutic management are the best for cure. Primary surgery is the best modality of treatment for medullary thyroid carcinoma even in metastatic MTC. The currently used multi-kinase inhibitors are characterized by high toxicity and drug resistance. Here we are presenting a case of locally advanced MTC which was managed by extensive surgery without compromising the quality of life. He had a significant drop in calcitonin levels after 4 months of surgery. So, we are so close to the normal calcitonin but so far for the cure. He was started on multi-kinase inhibitor cabozantinib in view of small pulmonary metastasis but was not tolerated because of side effects.
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