Save Your Thyroid with Jennifer Holkem

If you've been diagnosed with a thyroid nodule or thyroid cancer, the first option you probably heard about was surgery. Two surgeons from Weill Cornell Medicine want you to know that surgery isn't always the only answer, and that it hasn't been for years.

Dr. Thomas Fahey and Dr. Brendan Finnerty have spent nearly a decade building a high-volume thyroid ablation program. They treat benign nodules, toxic nodules, and carefully selected thyroid cancers without surgery. Many of their patients never heard about ablation from their own doctors. They found it themselves.

In this episode, we walk through three patient cases we see in this community all the time: a large benign nodule causing pressure symptoms, a toxic nodule that the patient's own doctors disagree about, and an indeterminate nodule where surgery was offered but molecular testing never was.

Dr. Thomas Fahey is Chief of Endocrine and Minimally Invasive Surgery and Professor of Surgery at Weill Cornell Medicine, where he has practiced for nearly three decades. He played an instrumental role in developing molecular testing for indeterminate thyroid nodules. As surgery program director, he has built pathways for surgical residents to learn interventional techniques like ablation.

Dr. Brendan Finnerty is Associate Professor of Surgery and Director of Interventional Endocrine Surgery at Weill Cornell Medicine. He performs radiofrequency and ethanol ablation for carefully selected nodules, cysts, and cancers. He also leads research into the mechanisms of tumor growth and metastasis.

🔗 Contact Dr. Fahey & Dr. Finnerty at Weill Cornell Medicine:

Request an appointment: https://weillcornell.az1.qualtrics.com/jfe/form/SV_3VFFcsKx0Z3RvEh

Phone: 646-962-5250

Dr. Fahey: [email protected]

Dr. Finnerty: [email protected]

🎥 Related: Indeterminate nodules & molecular testing with Dr. Joshua Klopper:

https://youtu.be/cP29-7nQu0M?si=hMvDDKaYqJh_B7Je

This episode is sponsored by Cambridge Interventional.

https://www.cambridgeinterventional.com/

📌 Resources:

👉 Podcast: https://www.saveyourthyroidwithjen.com/

👉 Patient site: https://www.saveyourthyroid.org/

👉 Private FB group: https://www.facebook.com/groups/saveyourthyroidnonsurgical

👉 Patient Navigation: https://www.saveyourthyroidwithjen.com/patient-navigation-services/

💛 Support the channel:

PAYPAL 👉 https://www.paypal.com/paypalme/itsmejenagain

VENMO 👉 https://account.venmo.com/u/itsme_jenagain

🛍️ Affiliate links:

🌿 TOUPS AND CO: https://toupsandco.com/jen

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⚠️ Disclaimer:

This podcast is for informational purposes only and is not a substitute for professional medical advice. No endorsement is given or implied for any specific product, treatment, or physician mentioned. Always consult with a qualified healthcare professional regarding your individual medical needs.

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Endocrine surgeon Dr. Salem Noureldine joins the show to break down toxic thyroid nodules — the ones that don't just sit there, but actively overproduce thyroid hormone and drive symptoms like a racing heart, weight loss, anxiety, and insomnia. From there, the conversation opens into the physics-level differences between radiofrequency and microwave ablation, why microwave can outperform RFA on vascular nodules affected by the "heat sink effect," and why patients with pacemakers may be safer candidates for microwave than RFA.

Dr. Noureldine is a fellowship-trained endocrine surgeon and assistant professor of surgery at George Washington University, where he founded the university's minimally invasive center and multidisciplinary thyroid tumor board. He holds a focused practice designation in thyroid and parathyroid surgery from the American Board of Surgery and serves as vice chair of NASIT's Guidelines and Statements Committee.

Connect with Dr. Salem Noureldine:

https://capitalmedicalgroup.com/profile/salem-noureldine

This episode is part of our sponsored series with Baird Medical.

bairdmed.com

If you're dealing with a toxic thyroid nodule, or trying to understand the real differences between ablation technologies before choosing one, this conversation gives you the questions to ask and the physics behind why they matter.

📌 Resources:

👉 Podcast: https://www.saveyourthyroidwithjen.com/

👉 Patient site: https://www.saveyourthyroid.org/

👉 Private FB group: https://www.facebook.com/groups/saveyourthyroidnonsurgical

👉 Patient Navigation: https://www.saveyourthyroidwithjen.com/patient-navigation-services/

👉 Find Dr. Noureldine: George Washington University / CMG Group [insert exact link]

💛 Support the channel:

PAYPAL 👉 https://www.paypal.com/paypalme/itsmejenagain

VENMO 👉 https://account.venmo.com/u/itsme_jenagain

🛍️ Affiliate links:

🌿 TOUPS AND CO: https://toupsandco.com/jen

🎙️ RIVERSIDE: https://www.riverside.fm/?via=itsmejenagain

🧴 VAN MAN: https://vanman.shop/?ref=itsmejenagain

💡 BON CHARGE: https://us.boncharge.com/?rfsn=7843863.50b9fa&shpxid=4137e8a5-8199-46cb-b71c-0f86d29324ff

⚠️ Disclaimer:

This podcast is for informational purposes only and is not a substitute for professional medical advice. No endorsement is given or implied for any specific product, treatment, or physician mentioned. Always consult with a qualified healthcare professional regarding your individual medical needs.

🎵 Music licensed through Soundstripe:

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Chapters

00:00 Introduction to toxic thyroid nodules

01:47 Dr. Noureldine's path into endocrine surgery and ablation

06:38 His role as vice chair of NASIT's Guidelines Committee

08:12 What is a toxic nodule?

09:58 Patient concerns by age group

10:47 Toxic nodules as an overlooked cause of AFib

12:17 RFA vs. microwave: the physics difference

15:23 Comparing ablation zone size

18:00 The heat sink effect in vascular/toxic nodules

20:10 Why RFA needs grounding pads (and microwave doesn't)

22:44 Procedure time and the patient experience

25:21 The "shape sorter" analogy for matching technology to patient

27:52 When ablation isn't the right choice

28:57 What to expect at a consult

32:41 Patient story: retreating a toxic nodule with microwave

37:47 Where to find Dr. Noureldine

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Most of what we cover on this show is the case FOR thyroid nodule ablation. This episode is the other side of that coin — and it's one every patient considering RFA, microwave, or nsPFA needs to hear.

"Just because you have a hammer doesn't mean everything's a nail. Ablation is a tool. It's not a philosophy."

Dr. David Goldenberg is Professor and Chair of the Department of Otolaryngology–Head and Neck Surgery at Penn State Health and Penn State College of Medicine. He is a head and neck surgical oncologist who has written more than 275 journal articles, 40 book chapters, and 8 books, and he leads Penn State's hands-on thyroid RFA training course. He performs thyroid surgery, thermal ablation, and nanosecond pulsed field ablation (nsPFA), so he evaluates every patient with all of those options on the table.

In this episode:

✅ Why ablation has grown so popular, so fast

✅ Where the evidence is strongest, and where it's still limited

✅ When size, location, or growth pattern points to surgery instead

✅ Why ablating a large thyroid cancer would leave cancer behind

✅ Substernal goiters, airway compression, and the "danger triangle"

✅ Multinodular goiter: when one nodule can be treated and when it can't

✅ Is a nodule ever too small, or too big, to ablate?

✅ Why thermal ablation is done awake, and why that isn't cruel

✅ His decision framework, with two real-world case examples

✅ The questions to ask before you commit (including the one no one asks)

✅ A thorough pre-ablation workup: labs, ultrasound, biopsy, and laryngeal exam

✅ Why Hashimoto's is NOT a reason to remove your thyroid

✅ Why "an ultrasound is a movie, not a picture"

If you've been told you're not a candidate for ablation — or you're wondering whether you are — this conversation will help you understand why.

Chapters

00:00 Introduction

01:57 Why ablation has grown so fast

03:24 Where enthusiasm has outpaced the evidence

04:29 Offering both surgery and ablation

05:50 When size, location, and growth mean surgery

11:02 Being awake during ablation and tolerating the procedure

14:53 Multinodular goiter

16:04 Why ablating a large cancer leaves cancer behind

18:45 Dr. Goldenberg's decision framework and case examples

22:09 Is a nodule ever too small or too big?

24:20 Questions to ask before you commit

28:02 The complete pre-ablation workup

29:52 Hashimoto's and the "it's dying anyway" myth

32:00 Advice for referring physicians

35:56 Ablation is a tool, not a philosophy

37:22 Why ultrasound is a movie, not a picture

39:36 Where to find Dr. Goldenberg

🔗 Penn State Health Otolaryngology–Head and Neck Surgery (Hershey, PA) — ask about thyroid nodule ablation:

https://www.pennstatehealth.org/services-treatments/radiofrequency-ablation

📌 Resources:

👉 Podcast: https://www.saveyourthyroidwithjen.com/

👉 Patient site & Find a Physician: https://www.saveyourthyroid.org/

👉 Private FB group: https://www.facebook.com/groups/saveyourthyroidnonsurgical

👉 Patient Navigation: https://www.saveyourthyroidwithjen.com/patient-navigation-services/

💛 Support the channel:

PAYPAL 👉 https://www.paypal.com/paypalme/itsmejenagain

VENMO 👉 https://account.venmo.com/u/itsme_jenagain

🛍️ Affiliate links:

🌿 TOUPS AND CO: https://toupsandco.com/jen

🎙️ RIVERSIDE: https://www.riverside.fm/?via=itsmejenagain

🧴 VAN MAN: https://vanman.shop/?ref=itsmejenagain

💡 BON CHARGE: https://us.boncharge.com/?rfsn=7843863.50b9fa&shpxid=4137e8a5-8199-46cb-b71c-0f86d29324ff

⚠️ Disclaimer:

This podcast is for informational purposes only and is not a substitute for professional medical advice. No endorsement is given or implied for any specific product, treatment, or physician mentioned. Always consult with a qualified healthcare professional regarding your individual medical needs.

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#ThyroidNodule #ThyroidAblation #SaveYourThyroid

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Interventional radiologist Dr. Sean Golden joins the show to talk through thyroid artery embolization (TAE) — a minimally invasive treatment that cuts off blood supply to an enlarged thyroid gland instead of removing or ablating it, with patients home the same day.

Dr. Golden co-built the TAE program at UW Health alongside Dr. Matthew Niemeyer, and brings a distinct perspective as a physician who came to TAE independently rather than through the more established training pathway.

In this episode:

✅ What TAE is and how it compares to surgery and ablation

✅ Step-by-step: what actually happens during the procedure

✅ Recovery — what to expect in the days and weeks after

✅ UW's hybrid CT angiography suite and why it matters

✅ GE's EmboAssist technology, explained

✅ Current research: contrast deposition, shrinkage timelines, and hormone changes post-procedure

✅ Who is (and isn't) a good candidate for TAE

✅ What Dr. Golden wishes every endocrinologist knew

If you've been researching non-surgical options for an enlarged thyroid or goiter, this conversation covers the clinical detail patients are usually not given.

Chapters:

00:00 Introduction to TAE & Dr. Sean Golden

01:29 What Is Interventional Radiology?

04:07 From Prostate to Thyroid: How Dr. Golden Got Into TAE

07:36 Building the UW TAE Program

09:47 Expanding Access in the Midwest

11:30 Walking Through the TAE Procedure Step-by-Step

14:10 How Fluoroscopy & Contrast Guide the Procedure

16:03 Choosing the Right Embolization Particles

19:09 Recovery: What to Expect After TAE

21:11 UW's Hybrid CT Angiography Suite

23:09 What Is GE's EmboAssist Technology?

27:35 Does the Roadmap Change Patient Selection?

28:17 Research: Can Contrast Predict Shrinkage?

29:48 Thyroid & Parathyroid Hormone Changes Post-TAE

31:42 Publishing Research & the PROTECT Trial

32:32 Who Is a Good Candidate for TAE?

34:03 Who Isn't a Candidate (and Stroke Risk)

36:42 The Multidisciplinary Care Team

37:50 Treating Graves' Disease with TAE

38:44 How Patients Find This Program

39:36 Results: 60% Volume Reduction Explained

42:06 Long-Term Follow-Up (5-Year Monitoring)

42:42 Where TAE Is Headed as a Field

43:37 What's Needed for Wider Physician Adoption

44:48 What Dr. Golden Wishes Endocrinologists Knew

46:33 Next Steps for Patients Considering TAE

📌 Resources:

👉 Podcast: https://www.saveyourthyroidwithjen.com/

👉 Patient site: https://www.saveyourthyroid.org/

👉 Private FB group: https://www.facebook.com/groups/saveyourthyroidnonsurgical

👉 Patient Navigation: https://www.saveyourthyroidwithjen.com/patient-navigation-services/

💛 Support the channel:

PAYPAL 👉 https://www.paypal.com/paypalme/itsmejenagain

VENMO 👉 https://account.venmo.com/u/itsme_jenagain

🛍️ Affiliate links:

🌿 TOUPS AND CO: https://toupsandco.com/jen

🎙️ RIVERSIDE: https://www.riverside.fm/?via=itsmejenagain

🧴 VAN MAN: https://vanman.shop/?ref=itsmejenagain

💡 BON CHARGE: https://us.boncharge.com/?rfsn=7843863.50b9fa&shpxid=4137e8a5-8199-46cb-b71c-0f86d29324ff

⚠️ Disclaimer:

This podcast is for informational purposes only and is not a substitute for professional medical advice. No endorsement is given or implied for any specific product, treatment, or physician mentioned. Always consult with a qualified healthcare professional regarding your individual medical needs.

🎵 Music licensed through Soundstripe:

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Most patients with low-risk papillary thyroid cancer are told there are two paths: surgery, or active surveillance. In this quick update, I'm sharing news of a first-in-human clinical trial that's testing whether there's a third option.

Researchers at Sarasota Memorial Health Care System and MD Anderson Cancer Center are evaluating nsPFA (nanosecond pulsed field ablation) — already FDA-cleared for benign thyroid nodules — to see if it can safely treat papillary thyroid microcarcinoma without surgery or thermal damage. The trial is led by Dr. Ralph Tufano (Sarasota Memorial) and Dr. Victoria Banuchi (MD Anderson), who reached out to me personally to help spread the word.

You may qualify if you have:

✅ Papillary thyroid microcarcinoma

✅ Tumor smaller than 1.5cm

✅ Cancer confined to the thyroid

✅ No lymph node involvement

✅ No spread beyond the thyroid

✅ Currently a candidate for active surveillance

Two enrollment sites: Sarasota, FL and Houston, TX. About 10 of 30 slots remain.

Learn more or see if you qualify:

📞 (941) 917-2225

📧 [email protected]

🔗 clinicaltrials.gov/study/NCT07218315

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The question this community has been asking since nsPFA first appeared on this podcast has finally been answered.

Does it last?

Professor Stefano Spiezia conducted the first-in-human feasibility study of nsPFA for benign thyroid nodules — and in 2026 he presented the durability data at the NASIT annual meeting in Portland, Oregon. Average 74% volume reduction at up to 22 months. Zero regrowth. Zero serious adverse events. And the nodule continued to shrink throughout the entire follow-up period.

Professor Spiezia is the Head of the Division of Endocrine and Ultrasound Guided Surgery at the Sea Hospital in Naples, Director of the Regional Reference Center for Thyroid Treatment, Adjunct Professor at the University of Turin, and Director of the Save Your Thyroid International School for Interventional Thyroid Procedures.

In this episode:

✅ Why nsPFA is a paradigm shift — not just another energy source

✅ How it works — programming cells to die, not burning them

✅ The 22-month durability data — 74% volume reduction, zero regrowth, zero serious adverse events

✅ Why the nodule kept shrinking throughout the entire follow-up

✅ 100% patient satisfaction with cosmetic appearance, 95% overall

✅ Why the absence of fibrosis and scarring changes everything

✅ Which nodules benefit most — especially those near critical structures

✅ Why nsPFA and RFA are complementary rather than competitive

✅ The regulatory landscape — FDA cleared in the US, CE mark pending in Europe

✅ The Save Your Thyroid International School — training physicians worldwide

If you have been waiting for the durability data on nsPFA before making a decision — this is the episode you have been waiting for.

Chapters

00:00 Introduction to Thyroid Nodule Treatments

01:04 New chapter

01:57 The Evolution of Non-Surgical Options

03:56 Understanding NSPFA: A Paradigm Shift

03:56 The Safety and Efficacy of NSPFA

15:39 Navigating Thyroid Nodule Diagnosis

44:09 Introduction to the Podcast and Resources

44:09 Navigating Thyroid Health and Community Support

🔗 Professor Spiezia & the Save Your Thyroid International School:

www.sytmedical.com

🔗 nsPFA Trial at MD Anderson & Sarasota Memorial (NCT07218315):

clinicaltrials.gov/study/NCT07218315

Contact: (941) 917-2225 or [email protected]

📌 Resources:

👉 Podcast: https://www.saveyourthyroidwithjen.com/

👉 Patient site: https://www.saveyourthyroid.org/

👉 Private FB group: https://www.facebook.com/groups/saveyourthyroidnonsurgical

👉 Patient Navigation: https://www.saveyourthyroidwithjen.com/patient-navigation-services/

⚠️ Disclaimer:

This podcast is for informational purposes only and is not a substitute for professional medical advice. No endorsement is given or implied for any specific product, treatment, or physician mentioned. Always consult with a qualified healthcare professional regarding your individual medical needs.

🎵 Music licensed through Soundstripe:

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"Well, better get it taken out."

That was the entire conversation after my thyroid biopsy. Then I waited six weeks for pathology — six weeks so frightening I didn't tell my own parents, and spent researching cancer treatments for a disease I didn't have.

Not one person told me that most thyroid nodules are benign.

If you've just been told you have a thyroid nodule, this episode is the information nobody handed me. No guest this week — just the conversation I wish someone had sat down and had with me on day one.

In this episode:

✅ The number nobody gives you — 90 to 95 out of every 100 thyroid nodules are benign, according to the American Thyroid Association

✅ What happens if it is cancer — why papillary thyroid cancer is one of the slowest-growing and most treatable that exists

✅ Why more than half of adults have a thyroid nodule and never know it

✅ What your ultrasound is actually measuring — risk features and TIRADS categories, not a diagnosis

✅ The Bethesda system explained, and how reliable a benign biopsy result really is

✅ Why a nodule diagnosis does not automatically mean surgery

✅ Active surveillance, radiofrequency ablation, microwave ablation, and other non-surgical options

✅ My own story — the nodule that grew to 4.5 x 7 cm, the years I lost to "take it out or leave it alone," and the outpatient procedure that shrank it by 90% and left my thyroid intact

It's okay to be scared. But you should know the odds are genuinely in your favor.

📚 Sources referenced:

American Thyroid Association — Clinical Thyroidology for the Public, December 2017

American Thyroid Association — Statement on ablation techniques for benign thyroid nodules, Thyroid, 2023

MedlinePlus Medical Encyclopedia

📌 Resources:

👉 Podcast: https://www.saveyourthyroidwithjen.com/

👉 Patient site: https://www.saveyourthyroid.org/

👉 Physician Finder — specialists in 50+ countries: https://www.saveyourthyroid.org/find-a-physician/

👉 Private FB group: https://www.facebook.com/groups/saveyourthyroidnonsurgical

👉 Patient Navigation: https://www.saveyourthyroidwithjen.com/patient-navigation-services/

💛 Support the show:

PAYPAL: https://www.paypal.com/paypalme/itsmejenagain

VENMO: https://account.venmo.com/u/itsme_jenagain

⚠️ This podcast is for informational purposes only and is not a substitute for professional medical advice. No endorsement is given or implied for any specific product, treatment, or physician mentioned. Always consult with a qualified healthcare professional regarding your individual medical needs.

Hosted on Acast. See acast.com/privacy for more information.

What if the surgeon sitting across from you told you that your thyroid cancer is not urgent — and that you have time to think, research, and explore all your options before committing to anything?

That's exactly what Dr. Melanie Goldfarb tells her patients. And she's an endocrine surgeon.

Dr. Goldfarb is a fellowship-trained endocrine surgeon, Professor of Surgery, and Director of the Center for Endocrine Tumors and Disorders at St. John's Cancer Institute in Santa Monica, California. As one of the first physicians on the West Coast to offer in-office RFA, she brings a genuinely unbiased perspective — she performs surgery AND ablation, so her recommendation reflects what's right for each patient, not the limits of what she can offer.

In this episode she joins Jennifer Holkem to cover the full landscape of thyroid nodule and cancer treatment — from realistic RFA expectations to a combination approach that could save half your thyroid.

In this episode:

What realistic RFA outcomes look like: The published definition of success is 50% volume reduction — Dr. Goldfarb achieves that 90-95% of the time but personally aims for 70-80%. Nodules under 4 to 4.5 centimeters typically need one session. Larger nodules may need more.

Goiter vs. nodule — why the distinction changes everything: A goiter is diffuse thyroid overgrowth. A nodule is a distinct, delineated growth. Thermal ablation is designed for nodules, not goiters. Getting this wrong leads to the wrong treatment conversation entirely.

Thyroid cancer and the 120% concept: Candidates for cancer ablation are the same patients who qualify for active surveillance — tiny papillary thyroid microcarcinomas under one centimeter, fully contained. The critical difference from benign treatment: you need 120% — the entire tumor plus a surrounding margin. Location is everything.

The lobectomy + RFA combination: For patients with one dominant side that is too large for ablation alone, Dr. Goldfarb removes that side surgically while using RFA to preserve the other. An innovative approach that saves half a thyroid for the right patient.

When proactive treatment makes sense: Her threshold is 3 to 3.5 centimeters. Serial ultrasounds consistently showing growth are an automatic reason to act. But not every nodule that exists needs treatment.

Active surveillance is a treatment: Watching is a conscious medical decision — not inaction. And the data is clear: even if a tiny thyroid cancer grows during surveillance, long-term prognosis is no different than treating it immediately.

Why thyroid cancer is almost never urgent: When a surgeon books you for surgery before you leave the office, that is scheduling efficiency — not a clinical emergency signal. True urgent thyroid cancer scenarios are genuinely rare. You have time.

The future of interventional thyroidology — in one word: non-invasive.

Find Dr. Goldfarb:

stjohnscancer.org/endocrine — telehealth consultations available via Zoom

Resources:

Podcast: saveyourthyroidwithjen.com

Patient site: saveyourthyroid.org

Private FB group: facebook.com/groups/saveyourthyroidnonsurgical

Patient Navigation: saveyourthyroidwithjen.com/patient-navigation-services

Support the channel:

PayPal: paypal.com/paypalme/itsmejenagain

Venmo: account.venmo.com/u/itsme_jenagain

Affiliate links:

TOUPS AND CO: toupsandco.com/jen

RIVERSIDE: riverside.fm/?via=itsmejenagain

VAN MAN: vanman.shop/?ref=itsmejenagain

BON CHARGE: us.boncharge.com/?rfsn=7843863.50b9fa&shpxid=4137e8a5-8199-46cb-b71c-0f86d29824ff

Disclaimer: This podcast is for informational purposes only and is not a substitute for professional medical advice. No endorsement is given or implied for any specific product, treatment, or physician mentioned. Always consult with a qualified healthcare professional regarding your individual medical needs.

Hosted on Acast. See acast.com/privacy for more information.

Most patients diagnosed with a thyroid nodule are offered two options: watch it or remove it. Andy Manos, PA-C is on a mission to make sure a third option reaches every community in the country.

As a physician assistant and VP of Internal Growth at North Star Vascular Interventional in Minneapolis, Andy performs thyroid radiofrequency ablation in a community-based interventional radiology clinic — no hospital required, no general anesthesia, same day in and same day out. In this episode he joins Jennifer Holkem to pull back the curtain on why so many patients are never told about nonsurgical options, how financial incentives can push physicians toward surgery, and what a single question can do to change the entire direction of a thyroid consultation.

He also breaks down thyroid artery embolization using the most accessible analogy I've ever heard — a water balloon, a garden hose, and a Costco run — and explains why the sub-sternal goiter that makes surgeons nervous is exactly the case where TAE shines.

In this episode:

• Why interventional radiology is reinventing itself as a patient-facing clinical specialty
• The financial realities that can push physicians toward surgery over ablation
• The five words every thyroid patient should ask their physician
• How thyroid artery embolization works — and which nodules it's best suited for
• Why RFA and surgery carry similar risks to the recurrent laryngeal nerve
• How AI and the internet are becoming legitimate tools for thyroid patient advocacy
• Why organ preservation is a movement happening across thyroid, uterus, and prostate care

Find Andy and North Star Vascular: northstarir.com

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If your thyroid biopsy came back inconclusive — Bethesda 3 or 4 — you may have been told surgery is your only option. But for decades, over 70% of those surgeries revealed nodules that were actually benign.

There's a better way. It's called molecular testing. And today's guest literally helped prove it works.

Dr. Joshua Klopper is the Medical Director for Endocrinology at Veracyte and a nationally recognized thyroid specialist with over two decades of experience managing thyroid nodules and thyroid cancer. He was an investigator on the original clinical study that validated the Afirma Genomic Sequencing Classifier — the test that has since helped millions of patients avoid unnecessary thyroid surgery. He served on the board of the American Thyroid Association and previously served as faculty at the University of Colorado School of Medicine.

⚠️ Conflict of Interest Disclosure: Dr. Klopper is an employee of Veracyte, maker of the Afirma Genomic Sequencing Classifier discussed in this episode.

In this episode, Dr. Klopper breaks down everything a patient needs to know about molecular testing — in plain language, without the jargon.

If you or someone you love has been told their thyroid biopsy is inconclusive — this episode could change the conversation with your doctor.

Chapters:

00:00 Introduction — The Indeterminate Thyroid Nodule Problem

01:55 Meet Dr. Joshua Klopper — Medical Director for Endocrinology at Veracyte

02:34 Understanding the Bethesda Classification System

05:38 The Human Cost of Unnecessary Thyroid Surgery

07:37 What Was the Patient Experience Before Molecular Testing?

10:18 What Is the Afirma Genomic Sequencing Classifier?

12:00 Why the Test Was Designed to Find Benign — Not Cancer

14:28 What Is a "Rule Out" Test and Why Does It Matter?

16:04 Oncocytic (Hurthle) Cells — Why They're Challenging

19:00 How Two-Thirds of Indeterminate Nodules Come Back Benign

21:27 Why It's Almost Always Safe to Pause Before Surgery

22:42 The Surgeon Bias Problem — Patients Deserve Options

25:37 How Patients Encounter Molecular Testing on Their Journey

29:43 What Happens to the Sample at Veracyte?

33:52 The 800-Patient Study — Long-Term Afirma Performance

41:24 What Does a Suspicious Afirma Result Actually Mean?

46:17 Risk of Malignancy — What the Numbers Really Mean

48:00 BRAF, RAS and Other Mutations Explained

53:30 The GRID Research Platform and Future Discovery

56:35 Molecular Testing and Ablation — What's Coming

58:33 One Message for Every Indeterminate Thyroid Patient

1:02:38 How to Learn More

1:05:56 Closing

📄 Study referenced in this episode:

Outcomes of Cytologically Indeterminate Thyroid Nodules Managed With Genomic Sequencing Classifier:

https://pubmed.ncbi.nlm.nih.gov/38415829/

🔗 Learn more about Afirma molecular testing:

https://www.veracyte.com/tests/afirma-thyroid/providers/

🔗 American Thyroid Association patient resources:

https://www.thyroid.org

🔗 Clinical Thyroidology for Patients (ATA):

https://www.thyroid.org/patient-thyroid-information/ct-for-patients/

📌 Resources:

👉 Podcast: https://www.saveyourthyroidwithjen.com/

👉 Patient site: https://www.saveyourthyroid.org/

👉 Private FB group: https://www.facebook.com/groups/saveyourthyroidnonsurgical

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