The PA Who's Bringing Thyroid Ablation to Your Community

Save Your Thyroid with Jennifer Holkem · Episode 124

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 today's episode, we're covering:

How interventional radiology is reinventing itself as a patient-facing specialty
Why patients aren't being told about nonsurgical options — including the financial realities involved
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

What Interventional Radiology Actually Is

Most people have never heard of interventional radiology. Until recently, IR existed behind the scenes — performing procedures based on orders from other physicians without patient-facing visibility.

That's changing fast.

IR uses imaging — ultrasound, X-ray, CT — to guide a needle or catheter to the right place inside the body and perform a therapeutic procedure. No large incisions. No general anesthesia in most cases. A band-aid at the end. Back to work the same day.

For thyroid patients that means evaluation, ablation, and follow-up — all outside the walls of a hospital, in a community clinic that's closer to where you live.

Why Patients Aren't Being Told About Their Options

Some of it is awareness — thyroid nodules may be a small part of a surgeon's practice and they simply haven't encountered the research or the conferences.

Some of it is financial. Andy said it plainly:

"The financial incentive to do surgery is real. It is a thing. And I think patients should know that."

A surgeon who takes patients to the OR gets paid more per case than one who performs ablation in clinic. That's a structural reality worth understanding when evaluating why you haven't been offered all your options.

The goal isn't to take patients from surgeons. It's to make sure patients know they have a choice.

The One Question That Changes Everything

If you've only been offered surgery or watchful waiting, ask your physician five words:

"Is there any other option?"

That question breaks a physician out of the routine thyroid visit and into a real conversation. You might get a referral. You might get a name. You might get an honest "I've heard of it but I don't do it — let me find out who does."

Any of those answers is progress. And as Andy puts it — you're not being difficult. You're being informed.

If your physician doesn't know where to point you, go to saveyourthyroid.org and click Find a Physician — a free, unsponsored list of physicians in the US and abroad who perform nonsurgical thyroid procedures.

Thyroid Artery Embolization — For the Nodules Others Can't Treat

Andy explained TAE using a water balloon analogy that finally makes the concept click.

Your nodule is like a water balloon slowly filling from a dripping faucet — fed by blood flow that also supplies everything else in your body that needs to stay functioning. TAE works like a plumber navigating your plumbing system to find and block only the faucet feeding that water balloon. Precisely. Strategically. Without touching anything else.

That's why TAE is the treatment of choice for sub-sternal goiters — thyroid growths that dive beneath the collarbone into the chest, pressing on nerves and blood vessels. Surgeons don't want to touch these cases. TAE doesn't need to reach the nodule directly. It just cuts off the supply.

"The sub-sternal goiter is where IR really shines. It's the nodule that makes surgeons nervous and it's exactly what TAE was built for."

The Nerve Risk Misconception

One of the most common reasons patients are steered away from RFA is concern about damage to the recurrent laryngeal nerve — the nerve controlling the vocal cords.

The research shows the risk is very similar between RFA and thyroid surgery. The misconception that surgery is safer for the nerve is not supported by the published evidence. If a physician has told you otherwise, ask them to point you to the research.

AI and the Internet Are Your Friends

Andy actively feeds AI platforms accurate information about thyroid ablation so that when patients search for alternatives to surgery they find real answers.

"I go on ChatGPT acting like I don't know what I'm asking — and it feeds me back a lot of my own content. Good. It's learning."

If your physician doesn't know about ablation — ChatGPT, Google, and saveyourthyroid.org are all legitimate starting points.

Organ Preservation Is a Movement

What's happening in thyroid care is part of something much bigger. The same shift that brought RFA and TAE to thyroid patients brought uterine fibroid embolization to women told a hysterectomy was their only option. It's bringing focal therapy to prostate cancer patients. Across specialty after specialty the mission is the same: treat the disease without sacrificing the organ.

"Organ preservation is not a trend. It's a movement. And it's happening across thyroid, uterus, prostate — everywhere."

Key Takeaways:

Ask "Is there any other option?" — it's the single most powerful question a thyroid patient can ask
TAE is the best option for sub-sternal goiters that other treatments can't reach
Financial incentives in surgery are real — understanding them helps you advocate better
RFA and surgery carry similar risks to the recurrent laryngeal nerve
AI and search engines are legitimate starting points for finding nonsurgical options
Organ preservation is accelerating across multiple medical specialties

Connect with Andy Manos and North Star Vascular Interventional:
🔗 northstarir.com

Find a physician near you:
🔗 saveyourthyroid.org

Book a patient navigation consult:
🔗 saveyourthyroidwithjen.com/p/patient-navigation-services

Disclaimer: None of the statements made in this or any other blog or video by Jennifer Holkem should be considered medical advice. Always consult with a qualified healthcare professional regarding your individual medical needs. — Jen