A. Do all thyroid nodules require surgery? The increasing incidence of thyroid nodules has attracted a lot of attention and many people are even afraid of talking about thyroid nodules. After physical examination, many colleagues are found to have thyroid nodules, and some of them are found to have thyroid cancer after surgery, which leads to many people wanting to get rid of thyroid nodules. In fact, most thyroid nodules are benign, although medical textbooks say that nodules larger than 25px need to be removed surgically because of the possibility of cancer and progressive enlargement. However, our long-term clinical work has shown that many thyroid nodules develop very slowly and the probability of malignancy is not high. Therefore, unless the nodule is large and produces symptoms of pressure or has become malignant, it should be removed surgically. Surgical treatment of thyroid nodules should be done with care and caution, as removal of the thyroid gland may require lifelong medication, and surgery carries many risks of complications, including hoarseness and numbness in some patients, and most patients will have significant surgical scars in the exposed anterior neck area after surgery, which can affect their lives and work. In the face of thyroid nodules, we should not only attach importance to it strategically, make regular follow-up and dynamic observation, but also defy it in the battle and don’t let it become a “heart disease” for you. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. Many patients go to the hospital because of neck discomfort, and an ultrasound reveals a nodule in the thyroid gland. At this time, many patients mistakenly believe that neck discomfort is caused by a thyroid nodule, and have a strong desire for surgery, thinking that surgery will solve the problem. Generally speaking, thyroid nodules rarely cause neck discomfort, it will only cause pressure symptoms such as difficulty in swallowing and breathing if the tumor is huge, or discomfort caused by tumor compression or invasion of nerves in the neck, but these cases are rare, especially for small thyroid nodules. In fact, most of the patients’ neck discomfort is due to cervical spondylosis or neck muscle strain, so patients should go to orthopedics or Chinese medicine and massage department for consultation. Is thyroid nodule a minor surgery? The thyroid gland is a very small organ, so many people mistakenly believe that the thyroid is a minor surgery and it doesn’t matter if they have a small incision. In fact, this is a big misconception. A leading American surgeon once said that thyroid surgery is the most challenging operation for a surgeon to perform. Why do you say so? First of all, the thyroid gland is one of the organs with the most abundant blood supply in the body, and it is very easy to cause heavy bleeding during surgery, thus “contaminating” the surgical field, interfering with the operation and making the operation more difficult. Although there are ultrasound knives and other “tools” to assist in surgery, they cannot completely eliminate intraoperative hemorrhage. Secondly, although the thyroid gland is a small organ, the place where it “lives” is also very small. The back two-thirds of the neck are muscles and vertebrae, while the front one-third of the space contains the thyroid gland, parathyroid glands, trachea, esophagus, carotid artery, jugular vein, recurrent laryngeal nerve, superior laryngeal nerve, cervical sympathetic nerve, celiac duct and many other important structures. They are very closely related to each other and can be damaged during surgery, resulting in adverse consequences. Again, many anatomical variations are often encountered in thyroid surgery, including variations in the course of the recurrent laryngeal nerve, called the laryngeal nerve, which can lead to postoperative hoarseness; variations in the number and location of the parathyroid glands, which can cause the parathyroid glands to be incorrectly cut or the blood supply to be severely damaged during surgery, resulting in postoperative numbness and convulsions in the hands and feet; especially in thyroid cancer surgery, not only is the thyroid gland completely cut, but also the lymph nodes around the affected side are cleared. In particular, in thyroid cancer surgery, not only is the thyroid gland completely cut, but also the lymph nodes around the affected side have to be cleared, all these operations are done next to the laryngeal nerve, which is less than 1mm thick, and around the parathyroid gland, which has a similar appearance to the lymph nodes. Therefore, this surgery is actually a “dance on the tip of the knife”, which requires a very high level of basic surgical skills and local anatomical understanding.