Whether a thyroid nodule is benign or malignant, a high level ultrasound can almost reach the level of a fine needle puncture pathology, so it is of great importance for both doctors and patients to read the ultrasound in your hands to make a careful judgment about surgery. The following are the malignant features of thyroid nodule ultrasound: 1. The internal echogenicity of malignant nodules is mostly “inhomogeneous” and the posterior echogenicity is diminished or absent. The longitudinal ratio of the nodule is close to 1, the peripheral border is unclear, the shape is not regular, or it is crabfoot-like, and there is no or no complete acoustic halo (dark ring) around the mass, etc. The possibility of malignancy should be considered. 3.Nodules that increase rapidly within a short period of time should be highly suspected of malignancy after intracapsular hemorrhage is excluded. 4. Microcalcifications are the most specific index for the diagnosis of thyroid cancer, especially for papillary carcinoma, which can be more than 90%. In addition, in young patients (less than 40 years old) and single nodule, the possibility of malignancy increases 4 times if calcification is found. 5.The elasticity score of nodules is 3 and 4. 6.The color Doppler flow imaging is divided into four types according to the distribution of blood flow within and around the tumor: Type I: no internal blood flow; Type II: little internal blood flow; Type III: peripheral blood flow; Type IV: internal linear branching blood flow. The distribution of blood flow in malignant nodules is mostly type III and IV. 7. The above signs are accompanied by lymph node metastasis in the neck. What kind of nodes need surgery? 1. Malignant nodules, regardless of size, should be operated. 2.Benign nodules with pressure symptoms or larger than 3 cm can be considered for surgery. 3.Posterior sternal goiter requires surgery. 4.Benign nodules with high thyroid function require surgery.