They may present in 1 of 5 different ways: most commonly as a thyroid lump (74% of sporadic presentations) (1); as a mass from metastatic disease (cervical lymph nodes or distant metastases); from symptoms secondary to elevated calcitonin (diarrhea, flushing) (10% of sporadic cases) (1); as ectopic Cushing syndrome (0.7%) (2); or detected after familial screening. The gene discussed is CALCA; the disease is metastatic neoplasm.