Medullary carcinoma of the thyroid gland is a neuroendocrine tumor-producing calcitonin and other substances such as serotonin, prostaglandins, carcinoembryonic antigen (CEA). It constitutes 8% of all thyroid cancers and is present in sporadic (80%) and family (20%) clinically presents as a painless hard and thyroid nodules, often with cervical lymphadenopathy. The surgery maneuver offers the only real chance of cure for medullary thyroid carcinoma since there is no firm evidence about the usefulness of adjuvant therapies. Male patient, 38 years old with a history of cervical tumor growth progressive, painless, intermittent dysphonia is that subsides with anti-inflammatory. On physical examination palpates conglomerate adenopathy in the neck jugular right carotid high, painless, fixed approximately 4 cm in diameter and no increase of thyroid gland expansion right lobe. The indirect laryngoscopy is paretic right vocal cord notes It is realized PAAF of carotid high right jugular region that informs accumulations of epithelial cells without significant atypia in the context of metastatic lymph nodes. The tomography of the neck with contrast informs an expansive process in the right cervical region of probable thyroid origin more right cervical lymphadenopathy. Total thyroidectomy is performed over the right posterolateral neck dissection and control on the left. If the pathology shows that informs medullary thyroid carcinoma with lymph node metastases in levels II, III, IV, VII. Send the patient of oncology for radiotherapy.