Medullary thyroid cancer (MTC) is considered as a rare thyroid cancer. Surgical approaches such as, total thyroidectomy and bilateral lymph node dissection, represent the first-line treatment. Persistent or increasing serum levels of tumor markers, such as CEA and calcitonin, imply residual or recurrent disease. An early and precise detection of recurrence is very important for guiding appropriate treatment. Recent developments in positron emission tomography (PET) imaging with different radiopharmaceuticals targeting specific hallmark of MTC, such as 18F-DOPA and 18F-FDG, have offered increased sensitivity for identifying recurrences. Moreover, the ability of conventional scintigraphic imaging to guide the surgical approach can be useful for the treatment of MTC recurrent patients. In the present work, we reported two cases of patients with recurrent MTC sending to surgical treatment guided by “nuclear medicine approaches”.