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:
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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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#ThyroidNodule #ThyroidAblation #SaveYourThyroid
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