Since the first realisation of the quantum anomalous Hall effect (QAHE) in a dilute magnetic-doped topological insulator thin film in 2013, the quantisation temperature has been limited to less than 1 K due to magnetic disorder in dilute magnetic systems. With magnetic moments ordered into the crystal lattice, the intrinsic magnetic topological insulator MnBi2Te4 has the potential to eliminate or significantly reduce magnetic disorder and improve the quantisation temperature. Surprisingly, to date, the QAHE has yet to be observed in molecular beam epitaxy (MBE)-grown MnBi2Te4 thin films at zero magnetic field, and what leads to the difficulty in quantisation is still an active research area. Although bulk MnBi2Te4 and exfoliated flakes have been well studied, revealing both the QAHE and axion insulator phases, experimental progress on MBE thin films has been slower. Understanding how the breakdown of the QAHE occurs in MnBi2Te4 thin films and finding solutions that will enable mass-produced millimetre-size QAHE devices operating at elevated temperatures are required. In this mini-review, we will summarise recent studies on the electronic and magnetic properties of MBE MnBi2Te4 thin films and discuss mechanisms that could explain the failure of the QAHE from the aspects of defects, electronic structure, magnetic order, and consequences of their delicate interplay. Finally, we propose several strategies for realising the QAHE at elevated temperatures in MnBi2Te4 thin films.