In our clinical work, one of the questions we often encounter is, “I recently had a checkup and found a mass in my thyroid, can the doctor help me see if I need surgery to remove it?” This is a difficult question to answer and involves many aspects. I will try to talk about some of my own views. 1. The need for surgical removal of a thyroid mass depends on the nature of its pathology. Even a very small thyroid nodule should be surgically removed if malignancy is clinically suspected, so the diagnosis is crucial. There are usually three methods that can help us make a diagnosis: high-quality ultrasonography, pathological examination of the mass by aspiration and endocrine thyroid function tests. With the results of these three tests and discussion with your doctor, you can get a more correct choice. 2. Benign thyroid swellings can be selected for observation or surgery. This decision needs to be made on an individual basis. If the benign goiter is relatively large and brings uncomfortable symptoms, such as swallowing discomfort, foreign body sensation, and pressure, surgical removal can be considered. There is no fixed standard for the exact size. In addition, surgery may also be an option for patients who experience a lot of psychological stress to remove concerns about the disease. For smaller lesions, cystic swellings, or thyroid swellings that have been clearly identified as benign by puncture pathology, clinical observation can be chosen. 3. Goiter with endocrine abnormalities should not be treated with immediate surgery. If there is abnormal thyroid function, including hyper and hypothyroidism, you should first go to the endocrinology department for medication and then have a doctor decide whether to have further surgery when needed. 4. In cases of clinically diagnosed thyroiditis, surgery is not the preferred treatment modality, and medical medication may be considered first, followed by surgery when needed.