Preoperative octreotide scintigraphy imaging has opened up a new era to approach recurrent medullary thyroid carcinoma (MTC). We describe the case of a 53-year-old woman who was diagnosed with recurrent MTC and elevated serum calcitonin level >2000 pg/mL. Preoperatively, Tc-99m HYNIC-TATE scintigraphy was used in identifying 2 focal abnormalities in the right upper cervical and left upper mediastinal regions, and a hand-held gamma probe was used intraoperatively to identify the hot areas. Six months after intraoperative dissection, serum calcitonin level and Tc-99m HYNIC-TATE scintigraphy were found normal. This case demonstrates the proper localization for recurrent MTC using Tc-99m HYNIC-TATE and a surgical gamma probe.