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.
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