There is not necessarily a positive correlation between the size of thyroid nodules and surgery. The need for surgery for thyroid nodules depends on whether there are somatic symptoms and whether there is malignancy. The common causes of thyroid nodules are excessive or low iodine intake, and the common lesions are: nodular goiter, inflammatory nodules, thyroid cysts, and tumor nodules. The first three types of lesions are mostly benign lesions. For patients without obvious clinical symptoms, surgery is not necessary, but daily review and attention to diet to reduce the stimulation of the nodules is sufficient. If the nodule is clearly tumorigenic, surgical treatment should be considered. Depending on the lesion, local thyroid excision should be done and nearby lymph nodes should be cleared to remove the primary lesion and cut off the metastatic pathway. In conclusion, whether a thyroid nodule requires surgery is not directly related to the size of the nodule, but mainly depends on the type of lesion and the overall situation of the patient. It is recommended to improve the examination and clarify the condition before considering the appropriate treatment plan.