We planned to do a study to document the various challenges faced by medical faculties while implementing the new competency-based curriculum for the medical graduates. The study was planned as a survey, and Google form-based questionnaire was sent to all faculties residing in Uttar Pradesh and who had completed curriculum implementation support program (CISP) workshop from King George's Medical College during years 2019–2020. The questions were designed keeping in mind the relevant issues such as time constraints, resources, team work, coordination, financial constraints, feasibility of practically implementing the new curriculum, and how mature are our students in adapting to the new methods of teaching. Many faculty members could not respond to the questionnaire as they were preoccupied with COVID pandemic crisis management. Majority of the faculties found mild to moderate level of difficulty in understanding the new curriculum. There was mixed response in regard to practical implementation of the new curriculum as 44% found moderate level of difficulty and resistance to adapt to the new system. Forty-three percent faced financial constraints in establishing the skills lab. Fifty-nine percent agreed that they had enough teaching learning methods. Majority found limited manpower, lack of enthusiasm, limited time especially in COVID pandemic, and online mode of teaching methods, lack of adequate resources, and difficulty in coordination as the challenging issues in implementation of the new curriculum. The solutions they suggested were to have regular meetings, listen to the problems and work on solutions, periodically motivate the faculties to adapt to the new system, train all faculties in CISP workshop, and to have short-term and long-term goals well defined to track the progress.

Dermoid cysts are rare, embryonically derived swellings that arise along line of embryonic fusion, usually in the midline of the neck. We report a rare case that was diagnosed clinically as a solitary nodule of the thyroid gland but was reported to be a dermoid cyst of the lateral cervical (thyrohyoid) region and discuss its etiopathogenesis, clinical presentation, imaging, and management.

Multiple endocrine neoplasia type 2B (MEN2B) is an extremely rare hereditary thyroid cancer syndrome. The individuals are presented with an aggressive form of medullary thyroid carcinoma (MTC). They have classic morphology features that aid in the diagnosis of the syndrome.

Head and neck paragangliomas (HNPGLs) are rare, rarely functional tumors known to have a genetic predisposition. Carotid body tumors (CBT) are the most common HNPGLs followed by jugular bulb tumors, vagus nerve, and tympanic plexus. The prevertebral region is not the known area for these tumors as seen in our case making it a rare case. Mutations in SDH-D linked genes are commonly associated with multiple HNPGLs. SDH-D mutations with single-gene deletion are rare as seen in the present case. Bilateral carotid body tumors need to be managed in a staged manner. Patients with HNPGLs need annual clinical, hormonal, and radiological, surveillance for early diagnosis and management. First-degree relatives, especially males, need surveillance as SDH-D mutations exhibit maternal imprinting. We describe here the management of a middle-aged male who came with neck swelling on evaluation and was found to have nonfunctional bilateral carotid body tumors, mediastinal, and a rare prevertebral tiny lesion.

Cutaneous metastasis in thyroid carcinoma is extremely rare (<1%) and usually accompanies follicular and papillary thyroid carcinoma (PTC). Less than 20 cases of anaplastic thyroid carcinoma with cutaneous metastasis have been described so far. We present a case of a 53-year-old male who presented with a longstanding thyroid swelling with a history of rapid increase for 2 months associated with bilateral cervical lymphadenopathy. Fine needle aspiration cytology revealed a variable picture from both lobes of the thyroid with PTC in the left lobe and anaplastic carcinoma in the right lobe. Total thyroidectomy with bilateral modified radical neck dissection was performed which supported the cytology findings. BRAF V600E and PD-L1 expression were analyzed using immunohistochemistry. Postoperatively, the patient received radioactive iodine ablation therapy, but developed cutaneous metastasis in the neck and thoracic region, which on fine needle aspiration cytology revealed metastatic anaplastic thyroid carcinoma. The patient did not respond to the therapy and succumbed to the disease within a month after surgery. Cutaneous metastasis may develop in thyroid carcinoma, which must be differentiated from skin adnexal malignancies due to different management strategies. BRAF V600E and PD-L1 expression in primary thyroid tumors can identify the possible cases who may benefit from immunotherapy, which can lead to an improved overall survival.

Background: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy after papillary thyroid Ca, but compared to papillary Ca, it has a greater tendency to metastasize to the lung (mc) and then the bones. The incidence of skull metastasis in FTC ranges from 2.5 to 5.8%, and in most reported cases, metastasis occurred after the diagnosis and treatment of primary tumor; but in few cases, skull metastasis becomes the presenting feature of an occult FTC. Herein, we report a patient with an occult FTC presenting with multiple pulsatile scalp metastases. Case: A 50-year-aged lady presented to surgical OPD with multiple scalp swellings for 1 year post trivial trauma. There were no other swellings in neck or other parts of the body or any complaints s/o of hypo- or hyperthyroidism. On examination, there were three pulsatile, nonmobile, irregular, firm-to-hard swellings on scalp; thyroid and neck examination were normal, and no lymph nodes were palpable. Contrast-enhanced computed tomography head and X-ray skull showed multiple focal lytic lesions involving outer and inner tables of the skull. Ultrasonography neck showed no thyroid nodules and no lymph nodes. Fine-needle aspiration cytology of scalp showed repetitive microfollicles and clusters of follicular cells s/o follicular thyroid Ca with scalp metastasis. Patient operated by palliative total thyroidectomy and referred for radioiodine ablation. Conclusion: Skull metastasis is a rare site for metastasis of FTC. In most reported cases, skull metastases of FTC were located in the skull base or occipital area. In our case, it was seen in occipital, parietal, and frontal bone. So thyroid examination and early detection and evaluation of thyroid nodules may help to diagnose thyroid carcinoma before distant metastasis occurs.

A poster presentation is an effective way to communicate the research in a short, concise, and informative format. These poster presentations are considered by many endocrine surgeons as an easy task, but actually require a lot of thought and preparation to achieve success. We present two different types of poster presentation: First one with 3D picture technique, and the second one, a video poster and how it impacted presentation.

Papillary microcarcinoma (PMC) is on the rise, and so is multifocal PMC. We present an image collage of a case of multifocal PMC and briefly review the literature.

Hyperparathyroidism occurs due to increased production of the parathyroid hormone (PTH) from the parathyroid glands. This can stem from abnormal secretion of the hormone as seen in primary and tertiary hyperparathyroidism. It can also be caused by defective homeostasis of the calcium metabolism, which can stimulate the production of PTH as in secondary hyperparathyroidism. The third most common endocrine disorder is primary hyperparathyroidism (PHPT), with its incidence being the highest among postmenopausal women. Seventy to eighty percent are asymptomatic, and the symptoms are related to chronic hypercalcemia rather than the elevated hormone levels. In the symptomatic group, nephrolithiasis is the most common followed by osteoporosis and increased fracture risk. With the advent of new diagnostic modalities, the severe presentation of the disease has decreased. Surgical excision of the gland(s) is a modality of choice for PHPT. Medical management is done using bisphosphonates, hormone replacement therapy, and calcimimetics and is usually required for mild disease. Secondary hyperparathyroidism occurs when the body tries to compensate for the low levels of ionized calcium by overproduction of the hormone. In the older population, vitamin D deficiency is a common cause of secondary hyperparathyroidism. Another cause is chronic kidney disease (CKD); these patients present with bone disease termed as osteodystrophy. It is also associated with cardiovascular disease and increased mortality. Treatment of secondary hyperparathyroidism is primarily medical using vitamin D supplements and calcium-based phosphate binders and calcimimetics. Dialysis is used for the management of acute nature. Tertiary hyperparathyroidism is usually a result of long-standing secondary hyperparathyroidism with autonomous parathyroid production. It can also occur with a few genetic diseases. Total parathyroid gland removal with autotransplantation in the forearm is the preferred management.