Medicine Episodes

Thyroid ablation vs surgery: how do you know which is right for you? Ablation has transformed care for thyroid nodule patients, but it isn't the answer for everyone. Dr. David Goldenberg, Professor and Chair of Otolaryngology–Head and Neck Surgery at Penn State Health, performs both thyroid surgery and ablation. He joins Jennifer Holkem to explain when ablation works best, when surgery is still the right call, and why a large thyroid cancer can't simply be ablated. We also cover multinodular goiter, whether a nodule can be "too small" to treat, Hashimoto's, and the one question almost no patient asks their doctor. "Ablation is a tool. It's not a philosophy." — Dr. David Goldenberg Connect with Dr. Goldenberg: https://www.pennstatehealth.org/services-treatments/radiofrequency-ablation Find a physician: https://www.saveyourthyroid.org/ This podcast is for informational purposes only and is not medical advice.

Interventional radiologist Dr. Sean Golden joins Jennifer Holkem to break down 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, who trained at Yale, the University of Wisconsin, and Johns Hopkins, co-built the TAE program at UW Health alongside Dr. Matthew Niemeyer. He brings a distinct perspective, having come to TAE independently after years performing prostate artery embolization — a procedure he explains shares striking similarities with TAE in technique, patient experience, and risk considerations. In this episode, Dr. Golden walks through exactly what happens during a TAE procedure, from catheter placement through particle embolization, and what recovery looks like in the days and weeks after. He explains UW Health's hybrid CT angiography suite and GE's EmboAssist technology — tools that help the team navigate precisely …

Does nsPFA actually last? Until now, that question didn't have a real answer. In this episode, Professor Stefano Spiezia joins Jennifer Holkem to break down the 22-month durability data on nsPFA — non-thermal pulsed field ablation for thyroid nodules — presented at the 2026 NASIT meeting in Portland. Professor Spiezia is head of the Division of Endocrine and Ultrasound Guided Surgery at the Sea Hospital in Naples, Italy, and conducted the first-in-human feasibility study of nsPFA for thyroid nodules. He's also director of the Save Your Thyroid International School for Interventional Thyroid Procedures. In this episode, they cover: ✅ The 22-month durability data: zero nodule regrowth, 74% average volume reduction, and no serious adverse events ✅ How nsPFA works differently from RFA and microwave ablation — a non-thermal mechanism that triggers regulated cell death instead of burning tissue ✅ Why nsPFA nodules kept shrinking over time instead of plateauing, unlike thermal ablat…

If you've just been told you have a thyroid nodule — or thyroid cancer — you're probably sitting with more fear than facts right now. Most patients are handed a referral and left to fill in the blanks alone, often without ever hearing the basic odds that would change how frightening this moment feels. In this solo episode, I'm sharing what I wish someone had told me on the day I was diagnosed. 🎧 We're covering: The real odds — what percentage of thyroid nodules are actually benign Why nodules are so common, and why most people never know they have one What your ultrasound results mean (the TIRADS system) What a biopsy result actually tells you, and how reliable a benign result really is Why a diagnosis doesn't automatically mean surgery — from active surveillance to non-surgical ablation My own diagnosis story, and what happened when my nodule was dismissed for years My own nodule was found by accident, dismissed by my ENT, and left untreated until it grew large enoug…

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 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 covers the full landscape of thyroid nodule and cancer treatment — from realistic RFA expectations to a combination approach that saves half a thyroid. In this episode: What realistic RFA volume reduction looks like — 50% is success but she aims for 70-80% Why goi…

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-stern In this episode: ✅ Why interventional radiology …

If your thyroid biopsy came back indeterminate — Bethesda 3 or 4 — you may have been told surgery is your only option. For decades, over 70% of those surgeries revealed tissue that was actually benign. There is a better way. It's called molecular testing. And today's guest helped prove it works. Dr. Joshua Klopper is the Medical Director for Endocrinology at Veracyte and was an investigator on the original clinical study that validated the Afirma Genomic Sequencing Classifier. He served on the board of the American Thyroid Association and spent over two decades managing thyroid nodules and thyroid cancer. Disclosure: Dr. Klopper is an employee of Veracyte, maker of the Afirma test discussed in this episode. In this episode Dr. Klopper breaks down everything a thyroid patient needs to know about molecular testing in plain language. Why the test was designed to find benign tissue rather than cancer. What a benign result actually means. Why a suspicious result doesn't automatically m…

For seven years, thyroid RFA in the United States has operated without formal standards. Any licensed physician could offer the procedure regardless of their training, case volume, or documented outcomes. That's changing. Dr. Jules Aljammal was the first endocrinologist in the US to perform thyroid RFA for benign thyroid nodules. Dr. Shahzad Ahmad has since performed the highest number of RFA procedures of any endocrinologist in the country. 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 to ask your provider right now — whether they are certified or not. In this episode: Why a medical license alone is not enough to safely perform thyroid RFA The 50-case minimum and what the certification actually…

Dr. Eren Berber is a Professor of Surgery at Cleveland Clinic and Director of Robotic Endocrine Surgery. He performed some of the first robotic thyroid operations in the US, brought thyroid RFA to Ohio, and has authored more than 350 scientific papers. His honest take on every major thyroid treatment option will surprise you. On robotic surgery: the only real advantage is avoiding a neck scar. Outcomes are not superior to conventional surgery — and he pioneered it. On ablation: he was skeptical initially. Four years of following his own patients changed his mind. Over 90% success rate in his first 100 RFA patients. Less than 5% complications. On the future: a nanopulse ablation trial is launching at Cleveland Clinic. ATA guidelines now formally include ablation as standard of care. On insurance calling RFA investigational: FDA cleared since 2018. CPT code active since 2025. That excuse is on borrowed time. Find Dr. Berber: Search his name at clevelandclinic.org and contact his o…

Here's the episode summary for Episode 120: For most thyroid patients, an indeterminate biopsy result with a 50% malignancy risk means one thing: surgery. Chelsie Paulson refused to accept that. Chelsie had two solid thyroid nodules — one on each lobe — when her Afirma molecular testing came back with a 50% risk of malignancy and a suspicion for follicular thyroid cancer. Four ENTs told her the same thing: the protocol is clear, remove the thyroid. Two nights before her scheduled thyroidectomy, at 2 a.m., she sent an email to Dr. Emad Kandil at Tulane University. She didn't expect much. Instead, Dr. Kandil called her personally the next morning and told her to cancel her surgery. She got on a plane that day. Chelsie underwent Microwave Ablation on both nodules — combining MWA for the solid tissue with ethanol ablation for the fluid-filled spaces. She paired the procedure with an aggressive integrative health protocol to support her body's healing from the inside out. The result…

For most thyroid patients, the path from diagnosis to treatment moves fast — sometimes too fast to stop and ask whether there's another way. Emily Saska's story started with a back scan. An incidental finding. A nodule she had never felt, never thought about, and never seen coming. Within weeks it was growing rapidly, visibly bulging in her neck, and she was sitting in an exam room being referred directly to a general surgeon — with no mention that any other option existed. Emily went home and Googled. She found the Save Your Thyroid community. She found Dr. Emad Kandil at Tulane University in New Orleans — an hour from her home in Baton Rouge. And she chose nanosecond pulsed field ablation — nsPFA — instead of surgery. The procedure happened on her 37th birthday. Her last memory before counting backwards from 10 was telling Dr. Kandil: happy birthday to me, hope you had your coffee. Three days later she was in Puerto Rico with her family. All she had was a band-aid. Six w…

For a long time, a thyroid nodule diagnosis followed a predictable path — symptoms appeared, surgery was scheduled, and the gland was removed. The question was never if you would have surgery. It was when. That's changing. And Dr. Ian Orozco is one of the physicians leading that change. Dr. Orozco is a board-certified interventional endocrinologist based in Provo, Utah, and one of the most experienced RFA providers in the Intermountain West. After five years performing RFA within a larger institution, he made a bold move — taking over the Thyroid Institute of Utah, the oldest thyroid-only practice in the state, and rebuilding it entirely around the modern thyroid patient. In this episode, he joins Jennifer Holkem to discuss what that independence means for patient care, why a thyroid-only practice produces a fundamentally different experience, and why the urgency you felt at the end of your surgical consult was probably more about the practice's schedule than your actual medi…

What does it take to bring cutting-edge, nonsurgical thyroid care to patients in smaller, underserved communities? In this episode, Jen sits down with Dr. Jacques Gaudet, a board-certified otolaryngologist and head and neck surgeon at Southern ENT Associates in South Louisiana, to find out. Dr. Gaudet traces his passion for thyroid care and ultrasound back to his medical training in the aftermath of Hurricane Katrina, when resource-scarce conditions pushed him to master diagnostic ultrasound on his own terms. That same persistence eventually led him to become the second physician in the entire state of Louisiana to offer thyroid RFA — not to chase a trend, but to give his patients real options. In this conversation, Dr. Gaudet and Jen cover: Why ultrasound expertise is non-negotiable for anyone performing RFA How he counsels anxious patients newly diagnosed with thyroid nodules What success actually looks like after RFA — and why symptom relief matters more than…

Anne Moeller had a multinodular goiter the size of a grapefruit that had grown significantly after two pregnancies, causing a severely deviated trachea and increasing pressure on her airway. With a thyroidectomy already scheduled, she stumbled across information about non-surgical thyroid treatments just weeks before her surgery date — and everything changed. In this episode, Anne shares how she went from knowing nothing about alternatives to surgery, to becoming her own most informed advocate. She walks us through her research process, how she found the Save Your Thyroid community, and why she ultimately chose thyroid artery embolization (TAE) with Dr. Juan Camacho over surgery. Anne also opens up about what the procedure was actually like as a patient, her gradual recovery, and how her thyroid function has remained stable throughout. As someone based in the UK navigating a healthcare system where TAE is only just emerging, her story offers a unique international perspective on wha…

Can you treat a thyroid nodule without heat or surgery? In this milestone episode of Save Your Thyroid, Jennifer Holkem welcomes back pioneer Dr. Emad Kandil, Chief of Endocrine Surgery at Tulane University, to celebrate a massive clinical achievement: completing over 100 cases using nPulse™ nanosecond Pulsed Field Ablation (nsPFA). While Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) use thermal energy (heat) to destroy nodules, nPulse is a non-thermal technology that uses ultra-fast electrical pulses to trigger apoptosis—natural cell death—at the cellular level. This means faster recovery, less post-op pain, and a new level of safety for nodules located near "danger zones" like the recurrent laryngeal nerve. 🔬 What We Cover in This Episode: -Thermal vs. Non-Thermal: Why "nanopores" are changing the game for precision and safety. -The 100-Case Milestone: Real-world clinical insights into patient recovery, NSAID use, and rapid volume reduction (often 70%+ in just o…

In this episode of Save Your Thyroid, Jennifer sits down with Tosin, a patient whose routine checkup revealed a complex multinodular goiter that had quietly grown down into his chest. Facing a highly invasive sternotomy to remove the mass and the prospect of lifelong medication, Tosin leaned into his curiosity and began searching for alternatives. His journey led him from Houston to Florida to undergo Thyroid Artery Embolization (TAE) with Dr. Juan Camacho. Tosin shares the realities of his diagnosis, what it feels like to undergo TAE, the temporary side effects of recovery, and the incredible news that his goiter shrank by over 80% in just six months—allowing him to keep his thyroid completely intact and fully functional.

Most patients with a massive thyroid goiter — especially one that has "dived" beneath the collarbone into the chest — are told the only option is a total thyroidectomy, often requiring a sternotomy to crack the chest bone and reach the tissue. Matthew Ashby faced exactly that crossroads. His massive multinodular goiter had grown silently for years until it began affecting his breathing. When his physicians told him surgery was his only path, he refused to accept that and started researching alternatives. What he found was Thyroid Artery Embolization — TAE. A minimally invasive procedure performed through a tiny access point in the wrist, with no chest-cracking required. No general anesthesia. No surgical scar. His goiter began to shrink. His thyroid stayed intact. In this episode Matthew shares his full journey — from discovering the goiter, to facing a sternotomy recommendation, to finding Dr. Juan Camacho and choosing TAE, to life on the other side. In this episode: W…

If you've been told your thyroid goiter is too large for RFA and that surgery — possibly including a sternotomy — is your only option, this episode is for you. Dr. Juan Camacho is a leader in Interventional Radiology at Radiology Associates of Florida and Sarasota Memorial. He joins Jennifer Holkem to discuss Pressure-Enabled Thyroid Artery Embolization — PED-TAE — a nonsurgical treatment showing remarkable results for massive goiters that thermal ablation can't adequately address. While RFA is often ineffective for thyroid volumes exceeding 20 mL, Dr. Camacho's clinical research shows a 73% mean volume reduction in massive goiters averaging 117 mL using PED-TAE. That's a game-changing number for patients who have been told nothing nonsurgical is available for their size. In this episode: Why large multinodular goiters often require more than thermal ablation How PED-TAE uses pressure to shrink thyroid tissue while preserving organ function Results from Dr. Camacho's lat…

The Future of Thyroid Treatment: Advanced RFA, Microcarcinoma, and Taiwan's "One-Stop Shop" Model 🇹🇼 This episode of Save Your Thyroid unveils the groundbreaking world of Thyroid Radiofrequency Ablation (RFA). Host Jennifer Holkem speaks with Dr. Chan Jung Chang, an expert Otolaryngologist from Taiwan, about the future of non-surgical thyroid treatment for both thyroid nodules and papillary thyroid microcarcinoma. Dr. Chang details why RFA is so widely preferred in Taiwan—driven by a...

What are the real risks of thyroid surgery? A top otolaryngologist (ENT) surgeon, Dr. Michael J. Wolfe, joins me to discuss how to protect your voice and parathyroid glands—and when non-surgical Radiofrequency Ablation (RFA) is a better option. In this episode, Dr. Michael J. Wolfe explains the crucial role ENTs play in thyroid care due to their deep expertise in neck anatomy. We explore the full diagnostic process for thyroid nodules, what your biopsy results really mean, and have a candi...

What's the hidden link between insulin resistance and thyroid nodules? Top endocrinologist Dr. Ahmet Ergin (@SugarMDs) joins me for an enlightening conversation about holistic thyroid health. In this powerful discussion, Dr. Ergin shares how integrative endocrinology, which blends traditional methods with functional medicine, is key to managing thyroid disorders. We explore the critical role of patient education and how lifestyle changes in diet, sleep, and exercise can profoundly impact y...

In this episode of Save Your Thyroid, Jennifer Holkem discusses the latest advancements in thyroid care, focusing on thyroid nodules and the innovative non-surgical treatment known as radiofrequency ablation (RFA). Joined by Dr. John Interlandi, they explore the history of thyroid treatment, the impact of nodular thyroid disease, and the benefits of RFA as a safe and effective alternative to surgery. The conversation emphasizes the importance of understanding thyroid health, the evolution of tre...

In this episode of Save Your Thyroid, host Jennifer Holkem interviews Natalie Suarez, who shares her personal journey with thyroid nodules and her experience with nanosecond pulse field ablation (nsPFA). The conversation covers Natalie's initial diagnosis, the challenges of navigating medical opinions and biopsies, and her decision to pursue nsPFA as a non-surgical treatment option. Natalie details her procedure day experience, recovery, and the positive outcomes she has experienced since the tr...

In this enlightening conversation, Dr. Merry Sebelik, a pioneer in the field of thyroid care, discusses the transformative impact of Radio Frequency Ablation (RFA) on thyroid treatment. She shares her journey as a surgeon and educator, emphasizing the importance of ultrasound in thyroid surgery and the global health implications of RFA. The discussion covers the advantages of RFA over traditional surgery, the challenges of implementing this technology in various healthcare settings, and the crit...