Advertise on podcast: Voices of Wisdom: A Podcast for Thyroid Clinicians

Dr. Naifa Busaidy joins host Dr. Dana Hartl to discuss the clinical decisions involved in systemic therapy for advanced metastatic thyroid cancer. They explore how disease progression, symptoms, tumor location and potential risks can inform when treatment may be considered, while recognizing that the decision is not the same for every patient. Dr. Busaidy describes how molecular testing can help inform treatment selection and why multidisciplinary communication matters, especially when local treatment options or potential complications are part of the discussion. She also shares how she approaches monitoring and side effect conversations, including ways clinicians can help patients understand what to watch for and when to reach out. The conversation turns to quality of life, patient goals and the challenges of discussing long-term treatment and prognosis. Dr. Busaidy reflects on the need for more research, clinical trials and better tools for goals-of-care conversations, while emphasizing that clinicians should engage patients and take their individual circumstances into account.

Part 2 turns from the proposed guideline framework to its potential use in practice. Dr. Mandel explains how clearer follow-up intervals may help de-escalate surveillance for benign nodules. She also identifies the clinicians most likely to use the planned app, particularly those who interpret ultrasound and make decisions about FNA. The conversation examines why thyroid ultrasound remains subjective, even as imaging technology improves. Dr. Mandel discusses commonly overcalled features, variation among readers and the importance of evaluating nodules through real-time imaging rather than relying only on selected static images. These limitations help frame both the promise and the challenge of using AI in thyroid ultrasound. Dr. Mandel sees an especially valuable role for AI in medical education, where it could help less experienced readers strengthen their interpretation skills. She also imagines future clinical tools that integrate patient factors, imaging and cytology into a more complete risk assessment. The episode closes on a personal note as she reflects on mentorship, curiosity, patient relationships and the importance of building a meaningful life beyond one’s career.

Dr. Susan Mandel traces her path into thyroid care back to mentorship, curiosity and an unexpected research opportunity. She explains how a practical need to perform ultrasound-guided biopsies more efficiently helped launch her work with thyroid nodules. What began as a way to obtain better samples from cystic or deep nodules soon revealed ultrasound’s much broader diagnostic potential. The conversation follows ultrasound’s evolution from a procedural aid to an essential tool for estimating malignancy risk. Dr. Mandel discusses improvements in probes and image processing, along with an enduring challenge: clinicians must learn how different machines and settings influence what they see. She also connects this progress to the Bethesda System and sonographic risk-stratification frameworks that helped shift practice away from biopsying every nodule above a certain size. Looking ahead, Dr. Mandel previews how the forthcoming ATA thyroid nodule guidelines may refine classification and support more patient-centered FNA decisions. She describes a planned app that would guide clinicians through nodule features, assign a sonographic category and provide supporting images. The discussion also explores how clinical history, comorbidities, nodule location and patient preference may help determine when biopsy or surveillance is appropriate.

Dr. Dana Hartl welcomes thyroid pathologist Dr. Zubair Baloch for a practical discussion of follicular-patterned thyroid lesions and why they remain challenging to classify. Dr. Baloch explains that “follicular” can describe both a cell of origin and a growth pattern, then walks listeners through the overlap among benign nodules, adenomas and carcinomas. He also clarifies why cytology can identify a follicular neoplasm but cannot reliably determine whether capsular or vascular invasion is present. The conversation explores how invasion affects diagnosis and prognosis. Dr. Baloch distinguishes capsular invasion from angioinvasion, explains why adequate tumor sampling is essential and discusses how the extent of vascular invasion can change clinical risk. He emphasizes that pathology terminology must be precise and descriptive, particularly because patients may see their reports before speaking with their clinicians. Dr. Hartl and Dr. Baloch also examine how molecular findings have reshaped thyroid tumor classification. They discuss the differing behavior of RAS-driven and BRAF-driven tumors, the separate classification of oncocytic carcinoma and the reasoning behind removing the word “carcinoma” from NIFTP. Dr. Baloch closes with a valuable reminder that pathology diagnoses should be grounded in everyday clinical practice, communicated clearly and written with patient management in mind.

In this episode of Voices of Wisdom, Dr. Erik Alexander joins Dr. Dana Hartl for a practical conversation about managing small thyroid nodules in an era of widespread ultrasound use and increasing incidental findings. The discussion centers on how clinicians can weigh nodule size, ultrasound features, cytology, patient age, comorbidities and personal risk tolerance when deciding whether to pursue FNA, active surveillance or treatment. One of the strongest insights is the importance of context. Dr. Alexander emphasizes that many thyroid nodules, and even some low-risk thyroid cancers, may never become clinically significant. Rather than defaulting to intervention, he frames care as a stepwise process with multiple points for reassessment, conversation and shared decision-making. The episode also explores the emotional weight of terminology, especially the word “cancer,” and how clinicians can help patients understand risk without minimizing their concerns. Dr. Alexander also looks ahead to the role of AI in thyroid ultrasound and cytology, while reinforcing that technology should support, not replace, clinician judgment and patient-centered discussion.

What happens when the evidence is incomplete, the terminology changes and the old follow-up habits no longer fit? In Part 2 of this thoughtful conversation, Dr. Julie Ann Sosa takes listeners into the gray zones of the 2025 ATA guidelines, from pathology and posterior tumors to surveillance limits and the future of decision support. It is a engaging conversation about where thyroid cancer care is becoming more precise and where the field still has hard questions to answer.

In Part 1 of their discussion, Dr. Dana Hartl and Dr. Julie Ann Sosa unpack the years-long process behind the update and the biggest shifts already changing how clinicians think about surgery, surveillance and personalized care. It is an inside look at guideline-making that feels as revealing as the recommendations themselves.

In part 2, we examine evolving surgical paradigms in medullary thyroid carcinoma, including staged surgery, de-escalation strategies and the use of frozen section findings to guide extent of resection. Dr. Lorenz also discusses follow-up after limited surgery and when neoadjuvant RET inhibitor therapy may make previously unresectable disease operable.

This two-part episode focuses on surgical decision making in medullary thyroid carcinoma, from patient selection to preoperative workup. Dr. Kerstin Lorenz explains how calcitonin levels, ultrasound findings and genetic considerations shape staging, imaging choices and the initial extent of surgery, with an emphasis on avoiding overtreatment while preserving curative intent.

In this second part of their discussion, Dr. Dana Hartl sits down with Dr. Zubair Baloch for a practical conversation on what actually makes thyroid FNA cytology reliable. The episode challenges common assumptions about “adequate” sampling and why that single step quietly shapes every diagnosis that follows. They also tease how molecular testing and AI can help, and when they can mislead, if the fundamentals are not right.

Thyroid cytology can be clear at the extremes, but uncertainty dominates the middle ground. In this episode, Dr. Zubair Baloch explores why indeterminate nodules challenge clinicians and how context, judgment, and collaboration shape better decisions. It’s a thoughtful look at what lies beyond Bethesda—and why everything matters.

In this episode, Dr. Dana Hartl speaks with Dr. J.P. Brito from the Mayo Clinic about the art and science of thyroid hormone replacement therapy. Together, they explore balancing TSH suppression, managing persistent symptoms, and understanding when “normal” lab results don’t tell the full story. Tune in for expert insights that challenge assumptions and highlight the power of individualized care.

What if surgeons could see nerve function in real time—and prevent injury before it happens? In this episode, Dr. Catherine Sinclair reveals how intraoperative neuromonitoring is reshaping thyroid surgery worldwide. From technical nuances to global access challenges, listeners gain a rare insider’s look at how innovation is transforming surgical precision.

Dr. Lisa Orloff shares practical, experience-driven tips for optimizing thyroid cancer ultrasound—from honing diagnostic skills and scanning overlooked areas to guiding surgery and follow-up care. Her expert insights help clinicians improve accuracy, integrate ultrasound into patient management, and adopt interactive techniques for better outcomes.

What happens when a cancer diagnosis impacts more than just your health? In this episode, Dr. Carrie Cunningham joins us to explore financial toxicity in thyroid cancer—what it is, why it matters, and how we can measure it. She also shares surprising insights about global policies and the promising role of AI in reducing patient burden.