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Background Medullary thyroid carcinoma (MTC) is a rare tumor. Fine-needle aspiration (FNA) cytology is a popular method for the preoperative diagnosis of MTC. Case Report A 45-year-old man was referred to our center for a palpable thyroid nodule. Ultrasound-guided FNA was carried out for the patient. Cytology slides showed many isolated and small clusters of round to oval cells, some with a moderate amount of cytoplasm and red cytoplasmic granules. Rare cells showed multiple red Auer rods. Histology confirmed the diagnosis of MTC. Concl