Multiple thyroid nodules are a common and frequent disease of the thyroid gland, and their incidence is increasing year by year, often requiring surgery. For unilateral or bilateral thyroid multiple nodules less than 1 cm, if there are no calcified foci, conservative treatment can be performed temporarily, i.e. no surgery is needed, as long as close follow-up is performed. For unilateral multiple nodules larger than 1 cm, unilateral total excision is possible, and postoperative treatment should be replaced by non-iodized salt and close follow-up of the contralateral thyroid. For bilateral multiple nodules larger than 1 cm, the surgical approach is more controversial. European and American experts believe that total bilateral thyroidectomy is the best treatment, based on the theory that it can remove both existing and potential lesions, avoiding the possibility of postoperative recurrence or malignancy of residual nodules, and avoiding the risk of postoperative recurrence and the need for reoperation to damage the laryngeal recurrent nerve. So far, there are no reports of postoperative complications of hypothyroidism such as immune deficiency and fatigue after total resection, but the biggest drawback is the lifelong replacement therapy with thyroxine preparations. My personal experience over the years is that preserving a small portion of normal thyroid tissue as much as possible during surgery can avoid the side effects of thyroxine replacement therapy, and at the same time can relieve a significant portion of patients of the psychological barriers and the trouble of taking medication for life.