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
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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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