Small cell variant of medullary thyroid carcinoma is an extremely rare histologic entity with a paucity of data. As such, there is a lack of clinical experience regarding this disease. In this case, a 52-year-old patient with small cell variant medullary thyroid carcinoma was experiencing intractable nausea, vomiting, and diarrhea. The initial workup was extensive yet unrevealing. He was refractory to all treatments. On further laboratory analysis, the calcitonin was substantially high and the thyroid stimulating hormone level was mildly elevated. This case is presented to highlight a possible treatment for this rare cancer through thyroxine suppression therapy. This case is presented due to the lack of literature available on small cell medullary thyroid carcinoma and also to discuss a possible direct relationship between thyroid stimulating hormone and calcitonin levels in this disease population.