Today we operated on a patient with a nodular goiter and intraoperative pathology confirmed cancerous lesions. Nodular goiter is very common in patients with a long history of the disease. It is often caused by iodine deficiency and is also known as macronodular disease. This disease is usually a benign lesion. However, some patients may require multiple surgeries because new nodules are constantly being created. However, some patients do not care because the nodules do not change much and for a long time. There are also patients who have had previous surgery but then develop new nodules and do not want to have another surgery. Unbeknownst to them, this disease can sometimes become cancerous. This is exemplified by the case we are treating today. When is surgery needed for nodular goiter? In general, surgery is needed if the nodule is large, such as 2 centimeters or more, or if the nodule is growing fast, or if the ultrasound examination is a hypoechoic nodule, especially if there is calcification. If you do not want to operate, you should also have a nodule puncture and send it for pathological examination, and if it is a benign nodule, you can continue to observe it. If it is a malignant lesion or cannot be ruled out, it should be surgically removed without hesitation to avoid future problems.