With the increased sophistication of modern ultrasound machines, nodules can be detected in about 50% of the normal population. So when you get a medical report that tells you that small nodules of a few millimeters in diameter have been found in your thyroid, it can be a little nerve-wracking. Of course, most nodules do not require surgery, and since the normal population has such a high rate of nodule detection, it is important to know exactly which nodules need to be treated. There are some people with small thyroid nodules, about 2-3 mm in diameter, which are the result of recent errors in examination or differences in subjective human opinions. Most of them are due to uneven glandular and follicular tissue within the gland, and some of them have large follicular tissue, and factors such as blood vessels and gliosis affect the visualization and can be ignored. Another condition is multinodular goiter, which is not strictly speaking a tumor. Nodules smaller than 1 cm usually do not require surgery and mostly appear as cystic or mixed cystic-solid nodules, unilaterally or bilaterally with multiple occurrences. Surgery is not recommended for young women with multiple small nodules. If the nodule is large, upper mediastinal lymph node examination is necessary and surgery is recommended. In addition, papillary carcinoma is the most common type of thyroid cancer, and it is reported that about 20-30% of the cases are bilateral, so total thyroidectomy is preferred for thyroid cancer. However, in our country, due to the national situation and doctors’ skills, most of them cannot perform total thyroidectomy, but at least total excision of one lobe plus regional lymphatic clearance is necessary. My personal opinion is in line with foreign countries, to perform total thyroidectomy, of course, intraoperative attention should be paid to the preservation of the paramedian glands, but the laryngeal nerve does not generally become a technical difficulty. At present, many units in China are gradually carrying out formal total thyroidectomy. Metastases to the thoracic lymph nodes can be cleared via open upper mediastinum, and the results are still good. A single parenchymal nodule with abundant blood supply and a high possibility of tumor should also be considered for surgical treatment. Bilateral benign larger nodules can be observed although they are obvious in appearance. Patients who are willing to undergo surgery can also undergo surgery, choosing near-total excision so that there will be no recurrence and because early microscopic cancer can occasionally be found in 7% of the operated glandular lobes, but patients are told to take medication for life. In conclusion, there is a tendency to over-operate benign thyroid nodules, but the incidence of malignant nodules has increased about 3 times in the last decade or so and is still on the rise, so timely examination is needed and consultation with a specialist will not delay the disease.