Indeterminate Thyroid Nodule? Up to 70% of Surgeries Weren't Necessary | Dr. Joshua Klopper

If your thyroid biopsy came back inconclusive — Bethesda 3 or 4 — you may have been told surgery is your only option. But for decades, over 70% of those surgeries revealed nodules that were actually benign. There's a better way. It's called molecular testing. And today's guest literally helped prove it works. Dr. Joshua Klopper is the Medical Director for Endocrinology at Veracyte and a nationally recognized thyroid specialist with over two decades of experience managing thyroid nodules and thyroid cancer. He was an investigator on the original clinical study that validated the Afirma Genomic Sequencing Classifier — the test that has since helped millions of patients avoid unnecessary thyroid surgery. He served on the board of the American Thyroid Association and previously served as faculty at the University of Colorado School of Medicine. ⚠️ Conflict of Interest Disclosure: Dr. Klopper is an employee of Veracyte, maker of the Afirma Genomic Sequencing Classifier discussed in this episode. In this episode, Dr. Klopper breaks down everything a patient needs to know about molecular testing — in plain language, without the jargon. In this episode: ✅ What Bethesda 3 and 4 actually mean — and why they create so much anxiety ✅ Why over 70% of surgeries for indeterminate nodules revealed benign tissue ✅ How the Afirma Genomic Sequencing Classifier works — and why it was designed to find the good stuff, not the bad ✅ What a benign Afirma result actually means for your risk level ✅ What a suspicious Afirma result means — and why it doesn't automatically mean cancer ✅ The multicenter 800-patient study that confirmed Afirma benign nodules behave just like cytologically benign nodules over time ✅ How specific mutations like BRAF V600E shift the risk of malignancy ✅ Why it is almost always medically safe to take a pause before agreeing to surgery ✅ How molecular testing is beginning to qualify patients for ablation instead of surgery ✅ Where this technology is heading in the next five to ten years If you or someone you love has been told their thyroid biopsy is inconclusive — this episode could change the conversation with your doctor. Chapters: 00:00 Introduction — The Indeterminate Thyroid Nodule Problem 01:55 Meet Dr. Joshua Klopper — Medical Director for Endocrinology at Veracyte 02:34 Understanding the Bethesda Classification System 05:38 The Human Cost of Unnecessary Thyroid Surgery 07:37 What Was the Patient Experience Before Molecular Testing? 10:18 What Is the Afirma Genomic Sequencing Classifier? 12:00 Why the Test Was Designed to Find Benign — Not Cancer 14:28 What Is a "Rule Out" Test and Why Does It Matter? 16:04 Oncocytic (Hurthle) Cells — Why They're Challenging 19:00 How Two-Thirds of Indeterminate Nodules Come Back Benign 21:27 Why It's Almost Always Safe to Pause Before Surgery 22:42 The Surgeon Bias Problem — Patients Deserve Options 25:37 How Patients Encounter Molecular Testing on Their Journey 29:43 What Happens to the Sample at Veracyte? 33:52 The 800-Patient Study — Long-Term Afirma Performance 41:24 What Does a Suspicious Afirma Result Actually Mean? 46:17 Risk of Malignancy — What the Numbers Really Mean 48:00 BRAF, RAS and Other Mutations Explained 53:30 The GRID Research Platform and Future Discovery 56:35 Molecular Testing and Ablation — What's Coming 58:33 One Message for Every Indeterminate Thyroid Patient 1:02:38 How to Learn More 1:05:56 Closing 📄 Study referenced in this episode: Outcomes of Cytologically Indeterminate Thyroid Nodules Managed With Genomic Sequencing Classifier: https://pubmed.ncbi.nlm.nih.gov/38415... 🔗 Learn more about Afirma molecular testing: https://www.veracyte.com/tests/afirma... 🔗 American Thyroid Association patient resources: https://www.thyroid.org 🔗 Clinical Thyroidology for Patients (ATA): https://www.thyroid.org/patient-thyro... 📌 Resources: 👉 Podcast: https://www.saveyourthyroidwithjen.com/ 👉 Patient site: https://www.saveyourthyroid.org/ 👉 Private FB group:   / saveyourthyroidnonsurgical   👉 Patient Navigation: https://www.saveyourthyroidwithjen.co... 💛 Support the channel: PAYPAL 👉 https://www.paypal.com/paypalme/itsme... VENMO 👉 https://account.venmo.com/u/itsme_jen... 🛍️ Affiliate links: 🌿 TOUPS AND CO: https://toupsandco.com/jen 🎙️ RIVERSIDE: https://www.riverside.fm/?via=itsmeje... 🧴 VAN MAN: https://vanman.shop/?ref=itsmejenagain 💡 BON CHARGE: https://us.boncharge.com/?rfsn=784386... ⚠️ 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