The thyroid gland is an uncommon site of metastatic disease. Renal cell carcinoma is the most common primary source, while metastasis from breast carcinoma is very rare. However, given that thyroid nodules are more common in women, and women with a history of breast cancer are at higher risk of developing thyroid cancer, the possibility of metastatic breast carcinoma must be considered when evaluating a thyroid nodule. We present the case of a 67-year-old woman who presented with dysphonia and dysphagia secondary to multinodular goiter and was found to have multifocal metastatic breast carcinoma in her surgical resection specimen. The histologic appearance focally mimicked C cell hyperplasia and medullary thyroid carcinoma, so immunohistochemistry was critical for establishing the diagnosis. Metastasis to the thyroid should always be included in the differential diagnosis for a thyroid nodule in a patient with a history of previous malignancy.

Introduction Medical simulation is a continuously expanding field. In surgical specialties, in particular, simulation can provide an alternative avenue for learning. The objective of this process improvement project was to evaluate the effectiveness and practicality of adding simulation-based training to our educational curriculum regarding common otologic procedures. Materials and Methods A low-cost, novel ear procedure simulator was designed and constructed from readily available clinic supplies. Participants were asked to fill out a pre-simulator survey to assess their own comfort and skill level before undergoing the simulation course. A pre-simulation PowerPoint training course was then administered to participants. The participants then underwent the simulation training course and were again asked to fill out a post-simulator training exercise survey to reassess their own comfort and skill level. Institutional review board approval was not required by Tripler Army Medical Center. Results A total of 15 participants consisting of junior residents in otolaryngology, third- and fourth-year medical students rotating on an otolaryngology clinical clerkship, and one physician assistant in otolaryngology were included in the study. There was a significant improvement in both provider comfort with the procedure and clinical performance of the procedure among participants after training on the simulation-based model. Conclusions Simulation-based training provides a safe, effective, and cost-friendly alternative to clinical medical education. Future studies are needed to address the wide-scale applicability of these results to other forms of surgical training.