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A conversation with the Endocrine Society’s president
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Susan J. Mandel, MD, MPH, associate chief of the division of endocrinology, diabetes and metabolism and co-director and creator of the Thyroid Nodule Clinic at the University of Pennsylvania, is the Endocrine Society’s 2018 president.
Mandel was instrumental in initiating the use of an ultrasound to characterize thyroid nodules and perform ultrasound-guided, fine-needle aspiration biopsies of thyroid nodules in the United States before it was accepted as routine.
Endocrine Today spoke with Mandel about her interests in the fields of thyroidology and endocrinology, her accomplishments and advice for medical students.
What area of your field most interest you right now and why?
Mandel: I am the Endocrine Society incoming president, but I’m also a thyroid doctor, so when you ask me what interests me personally, it’s going to be about thyroid. The genetics of thyroid cancer are propelling the field forward at a faster rate that I’ve seen in my almost 30-year career — whether we’re using molecular testing for diagnosis or targeting therapy for advanced thyroid cancer based upon specific oncogene mutations in tumors and extending life--it’s fantastic.
In the broader field of endocrinology, the role of technology and its applications to research and patient care is transforming our field.
In addition, basic science is driving clinical care. For example if you look somatic genetic mutations in tumors and target therapy to that, you could be using the same drug to treat a patient with metastatic salivary gland cancer, metastatic thyroid cancer, metastatic pancreatic cancer, because therapy is based upon the mutation of the tumor, not the organ from which it originated. And heritable genetic changes have implications as well, beyond development of disease but also for pharmacologic response to therapy—the field of pharmacogenomics. It may be that based upon certain mutations that you have, you may have a different response to drugs.
What do you think will have the greatest influence on your field over the next 10 years and why?
Mandel: The pipeline— are there going to be endocrinologists in 10 years that take care of endocrine patients? Are there going to be investigators identifying as endocrinologists doing research? We know about the increasing burnout for our clinical endocrinologists, with reimbursement challenges, pressures to see patients, time constraints associated with the electronic health record. There is already such a time lag to be able to see an endocrinologist in practice because schedules are so full. And, we want people to go into endocrinology because endocrinology is fascinating medicine. For our scientists, endocrinology has always been the poster-child of translational medicine, we find these great things in the lab and then use discovery to propel clinical medicine
In fact, at the Endocrine Society meeting, some of the plenaries yare focused on translating what you discover in the lab into a drug. One of the plenaries is “Translating Basic Discovery into Reproductive Health.” So how do we fund basic discovery? This is a challenging time for NIH funding. How do we keep basic science going? How do we get people interested in doing endocrine research so they can be the next generation of discoverers that then propel clinical care forward? And if not NIH funding, how do you fund research? Do we need to look for other sources, like public-private partnerships, to fund research? The Endocrine Society, in partnership with our sister societies, has been very active in advocacy efforts to support all of these issues.
What are some of the most exciting advances that you have been a part of?
Mandel: Since my fellowship in 1990, I have been part of two fields in clinical thyroidology: sonography of thyroid nodules and thyroid disease and pregnancy
I literally entered on the ground floor with ultrasound, doing my first thyroid ultrasound in 1990. At that time biopsy was recommended for all nodules larger than one centimeter. And now, 28 years later in this journey and we are no longer doing biopsy based upon size alone. The field has advanced based upon the combined efforts of endocrinologists and radiologists. We now use ultrasound to stratify risk. How can we use sonography to help us make decisions that will lead to important and meaningful results for our patients? I’ve been very fortunate to be on the American Thyroid Association guideline committee to help develop the nodule sonographic pattern system that is one of the systems being used by many today for decision-making.
My interest in thyroid disease and pregnancy began when I was fellow. My mentor and I did the research that first demonstrated that pregnant women who are hypothyroid require a higher dose of thyroid hormone during pregnancy. To be part of the group that published this finding is really impactful—just thinking of all of the lives affected by the idea that my mentor Reed Larsen had. At this time in my career, being a fellowship program director is my passion; I am privileged to train the next generation for our field and their success is my goal
What advice would you offer a student going into endocrinology today?
Mandel: Mentorship is critical and in actuality, it continues lifelong—providing the foundational support to pursue your goals in your chosen aspect of endocrinology. Clinical endocrinology is so attractive. As an endocrinologist, you provide meaningful care to improve the quality of patients’ lives. Endocrinology basic science is the pipeline for what we do in translational research and clinical care. My advice is: Be passionate and committed to your field. Find a good mentor because even if you are committed to an area, you need someone to help steer you along. That’s important for success.
What are your hobbies or interests outside of work?
Mandel: I have a family, two adult children and we do a lot of things together. My husband and kids keep me grounded. I love to ski, now a family passion. My husband and I took up ballroom dancing about 2 years ago, just getting going on this. And, I like to read — one of the nice things about those long plane rides for me — it lets me catch up on reading. – compiled by Amber Cox
Disclosure: Mandel reports no relevant financial disclosures.