The metabolic status of the patient previously reported1 was studied periodically, and during the summer of 1957 hypercalcemia and hypophosphatemia developed without subjective symptoms. It was felt that the malignancy had recurred, and operation was advised; but the patient postponed surgical intervention until Dec. 3, 1957, by which time a small nodule had become palpable in the left side of the neck. At the time of exploration recurrent tumor was found locally in the thyroid fossa, and there was lymphatic spread in the superior mediastinum. In addition, there was a metastatic nodule in the sternothyroid muscle. The sternothyroid and sternohyoid muscles were completely excised, and all gross tumor was excised en bloc. In the immediate postoperative period this patient again had clinical pancreatitis and an associated elevated serum amylase concentration. At the present time the patient is receiving deep x-ray therapy to the neck and upper mediastinum.