Aims: This review examines two medullary thyroid cancer (MTC) cases managed at a tertiary hospital in Victoria, Australia, and compares Australian practices to international guidelines. Case Series: Case 1: A 31-year-old female presented with an asymptomatic 8mm right thyroid nodule, growing from 5mm in 6 months. Fine-needle aspirate (FNA) suggested MTC. Imaging revealed ipsilateral neck nodes with pathological calcifications. Preoperative calcitonin was 1699 pmol/L, and CEA was 330 ng/L. She underwent total thyroidectomy, central neck dissection, and bilateral lateral selective neck dissections. Histopathology confirmed an 11mm low-grade MTC with nodal metastases in levels VI, VII, ipsilateral II-IV, and contralateral IV. Postoperative calcitonin showed a partial biochemical response (882 pmol/L). Case 2: A 53-year-old male with a palpable 88mm left thyroid nodule underwent FNA, suspicious for MTC. Imaging identified a prominent left level IV node. Preoperative calcitonin was 2186 pmol/L, and CEA was 383 ng/L. He underwent total thyroidectomy, central neck dissection, and left level II-IV neck dissection. Histopathology confirmed a 60mm low-grade MTC with central and lateral neck nodal metastases. Postoperative calcitonin normalized to 1.4 pmol/L, with mildly elevated CEA (24.6 ng/L). Literature Review: A systematic search of 33 articles and 7 guidelines (USA, Europe, UK, Poland, Brazil) showed universal recommendations for preoperative staging with ultrasound, CT neck, and serum calcitonin/CEA, with some suggesting CT chest/abdomen/pelvis for metastasis. Total thyroidectomy and central neck dissection were advised. Lateral neck management varied: ATA recommended dissection for radiologically proven disease, while others advised ipsilateral lateral dissection for calcitonin >200–500 pmol/L. Results: Australian MTC management aligns with international guidelines for thyroid and central neck treatment, with lateral neck approaches consistent with ATA recommendations.