Save Your Thyroid with Jennifer Holkem

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.Chapters00:00 Introduction01:57 Why ablation has grown so fast03:24 Where enthusiasm has outpaced the evidence04:29 Offering both surgery and ablation05:50 When size, location, and growth mean surgery11:02 Being awake during ablation and tolerating the procedure14:53 Multinodular goiter16:04 Why ablating a large cancer leaves cancer behind18:45 Dr. Goldenberg's decision framework and case examples22:09 Is a nodule ever too small or too big?24:20 Questions to ask before you commit28:02 The complete pre-ablation workup29:52 Hashimoto's and the "it's dying anyway" myth32:00 Advice for referring physicians35:56 Ablation is a tool, not a philosophy37:22 Why ultrasound is a movie, not a picture39:36 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/itsmejenagainVENMO 👉 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:GKLLAMF1GLKROGMQUDCFUKGJHFQUE3WA#ThyroidNodule #ThyroidAblation #SaveYourThyroid

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 knewIf 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 Golden01:29 What Is Interventional Radiology?04:07 From Prostate to Thyroid: How Dr. Golden Got Into TAE07:36 Building the UW TAE Program09:47 Expanding Access in the Midwest11:30 Walking Through the TAE Procedure Step-by-Step14:10 How Fluoroscopy & Contrast Guide the Procedure16:03 Choosing the Right Embolization Particles19:09 Recovery: What to Expect After TAE21:11 UW's Hybrid CT Angiography Suite23:09 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-TAE31:42 Publishing Research & the PROTECT Trial32:32 Who Is a Good Candidate for TAE?34:03 Who Isn't a Candidate (and Stroke Risk)36:42 The Multidisciplinary Care Team37:50 Treating Graves' Disease with TAE38:44 How Patients Find This Program39:36 Results: 60% Volume Reduction Explained42:06 Long-Term Follow-Up (5-Year Monitoring)42:42 Where TAE Is Headed as a Field43:37 What's Needed for Wider Physician Adoption44:48 What Dr. Golden Wishes Endocrinologists Knew46:33 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/itsmejenagainVENMO 👉 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:LWEQ1ULKFKSZCJAI1V2EQXECZBOZ1GND

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 surveillanceTwo enrollment sites: Sarasota, FL and Houston, TX. About 10 of 30 slots remain.Learn more or see if you qualify:📞 (941) 917-2225📧 researchinstitute@smh.com🔗 clinicaltrials.gov/study/NCT07218315

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 worldwideIf you have been waiting for the durability data on nsPFA before making a decision — this is the episode you have been waiting for.Chapters00:00 Introduction to Thyroid Nodule Treatments01:04 New chapter01:57 The Evolution of Non-Surgical Options03:56 Understanding NSPFA: A Paradigm Shift03:56 The Safety and Efficacy of NSPFA15:39 Navigating Thyroid Nodule Diagnosis44:09 Introduction to the Podcast and Resources44:09 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/NCT07218315Contact: (941) 917-2225 or researchinstitute@smh.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/⚠️ 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:1G4WWNUWW7H8MYH4VRP5MQM1YSHICQLR1NSDN1IASZTIWC21

"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 intactIt'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 2017American Thyroid Association — Statement on ablation techniques for benign thyroid nodules, Thyroid, 2023MedlinePlus 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/itsmejenagainVENMO: 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.

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 ZoomResources:Podcast: saveyourthyroidwithjen.comPatient site: saveyourthyroid.orgPrivate FB group: facebook.com/groups/saveyourthyroidnonsurgicalPatient Navigation: saveyourthyroidwithjen.com/patient-navigation-servicesSupport the channel:PayPal: paypal.com/paypalme/itsmejenagainVenmo: account.venmo.com/u/itsme_jenagainAffiliate links:TOUPS AND CO: toupsandco.com/jenRIVERSIDE: riverside.fm/?via=itsmejenagainVAN MAN: vanman.shop/?ref=itsmejenagainBON CHARGE: us.boncharge.com/?rfsn=7843863.50b9fa&shpxid=4137e8a5-8199-46cb-b71c-0f86d29824ffDisclaimer: 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.

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 specialtyThe financial realities that can push physicians toward surgery over ablationThe five words every thyroid patient should ask their physicianHow thyroid artery embolization works — and which nodules it's best suited forWhy RFA and surgery carry similar risks to the recurrent laryngeal nerveHow AI and the internet are becoming legitimate tools for thyroid patient advocacyWhy organ preservation is a movement happening across thyroid, uterus, and prostate careFind Andy and North Star Vascular: northstarir.com

How do you know if the doctor performing your thyroid RFA is truly qualified?It's the question every patient asks — and until now, there hasn't been a clear answer. A medical license isn't enough. General board certification isn't enough. And with RFA growing rapidly in the US, the gap between trained specialists and general providers is becoming a real patient safety issue.That's exactly why two of the most accomplished names in thyroid ablation have spent years building a solution.Dr. Jules Aljammal is the very first endocrinologist to perform thyroid RFA for benign thyroid nodules in the United States. Dr. Shahzad Ahmad has performed the highest number of RFA procedures of any endocrinologist in the country, achieving multiple North American firsts along the way. Together, they are the founder and president-elect of NASOIE — the North American Society of Interventional Endocrinology — and the architects of the first formal certification program for RFA providers in the US.In this episode, they break down exactly what that certification requires, what it means for patients, and what questions you should be asking your provider right now — whether they're certified or not.In this episode:✅ Why a standard medical license is not enough to safely perform thyroid RFA✅ What the new NASOIE certification requires — including the 50-case minimum and outcome review✅ The two certification levels: Certificate of Interventional Endocrinology and Master of Interventional Endocrinology✅ The three questions to ask any prospective RFA physician before your procedure✅ Why treating thyroid cancer with ablation requires a different mindset — and significantly more experience✅ Why continuity of care after ablation is non-negotiable✅ Where to find certified physicians and how NASOIE is building that map✅ Where RFA adoption is headed in the next five to ten yearsIf you are currently searching for an RFA provider — or you want to verify that the one you've already found is truly qualified — this episode is essential listening.CHAPTERS00:00 Introduction01:00 Meet Dr. Ahmad & Dr. Aljammal — The Pioneers Behind US Thyroid RFA03:38 The Birth of NASOIE & Bringing RFA to the United States08:05 The Wild West Problem — Why Standardization Is Urgently Needed09:37 Patient Safety & the Real Risks of Untrained Providers12:30 The 50-Case Minimum & What Certification Requires16:08 How New Providers Can Build Toward Certification17:45 Ongoing Education & What Happens After Certification20:20 How Patients Can Find Certified Physicians24:15 Why Anecdotes Aren't Enough — The Case for Verifiable Standards26:32 Top 3 Questions to Ask Your RFA Doctor Before Your Procedure31:32 Volume, Published Outcomes & PubMed Transparency33:09 Treating Thyroid Cancer with Ablation — A Different Mindset38:45 Knowing When NOT to Perform Ablation41:50 Continuity of Care — Why Follow-Up Is Non-Negotiable42:35 Where Is RFA Headed in the Next Five Years?45:36 How to Find Dr. Ahmad & Dr. Aljammal🔗 Find Dr. Shahzad Ahmad:Endocrinology Center of Utah: thyroidradiofrequency.com🔗 Find Dr. Jules Aljammal:Thyroid Clinic Utah: thyroidclinicutah.comThyroid Clinic Washington: thyroidclinicwashingon.com🔗 NASOIE — North American Society of Interventional Endocrinology:nasoie.com⚠️ 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:Y4XYU0XSPNNR5RI3