The treatment of a 10-year-old girl with many thyroid nodules in her neck should be decided on the basis of the specific findings as well as the condition. If ultrasonography suggests microcalcification, suspicious lymph nodes and irregular margins, malignancy is highly suspected. Ultrasound-guided fine-needle aspiration is feasible to clarify the diagnosis, and if malignant, surgical treatment can be taken. If thyroid nodules are found in children, more comprehensive examination is needed, such as thyroid function measurement or ultrasound to observe the shape, border and blood flow signal of the nodules. If the nodule is benign, ultrasound, including thyroid ultrasound and cervical lymph node ultrasound, can be repeated periodically. If the nodule is stable, the ultrasound should be reviewed every 1 to 2 years. If the nodule is enlarged or new suspicious ultrasound features appear, the risk of thyroid cancer in the nodule is considered, and ultrasound-guided fine-needle aspiration can be performed. Considering the higher risk of malignancy in thyroid nodules in children compared with adults, if ultrasound-guided fine-needle aspiration results are of equivocal or suspicious significance, surgery, usually lobectomy plus isthmus resection of the thyroid gland, is recommended. The routine use of levothyroxine to treat benign thyroid nodules in children is neither recommended nor opposed. Children with thyroid nodules are advised to seek prompt medical attention.