In the past few days, an article about the top 10 overtreatments in medicine has been making the rounds in doctors’ circles, and thyroid surgery, especially microscopic thyroid cancer, is among them. Is microscopic thyroid cancer really over-treated? The reasons listed in the article are mainly that the incidence of thyroid cancer has increased significantly due to the widespread use of high-resolution ultrasound for medical examinations, the most famous example being Korea in the last two decades, where the incidence has increased nearly ? times and has become the number one cancer incidence among women in Korea. Shanghai has ranked fourth for women. The rise in incidence has led to a significant increase in surgery rates. The article argues that thyroid surgery has caused pain to patients, inevitable complications from damage to the laryngeal recurrent nerve and parathyroid glands, and long-term medication, while there has been no increase in mortality due to thyroid cancer, which smacks of overtreatment. After talking with many doctors in thyroid surgery, endocrinology, and nuclear medicine, we believe that it may be too early to draw this conclusion. The prognosis of thyroid cancer is excellent, and papillary cancer is classified as stage II (early) before the age of 45, even if there are distant metastases. So it is a bit far-fetched to conclude that there is no increase in mortality to overtreat. The authors often encounter extreme cases in clinical practice, where the tumor metastasizes extensively in a few millimeters or even without seeing the primary focus, and in such cases the prognosis is poor. There are also some tumors growing in the laryngeal recurrent nerve and tracheoesophageal parietal, and the enlargement may invade the above organs, which may have a high disability rate if not operated in time. Although the above cases are small probability events, the consequences are very serious. What to do when encountering microscopic thyroid cancer, precise medical treatment is especially important at this time. It is necessary to make a choice according to the patient’s general condition, tumor site and psychological situation. For microscopic cancer that is older and has more other systemic diseases, follow-up should be the first choice. It is possible that the tumor may not change for several years or ten years after follow-up, which will not affect the patient’s survival and quality of life, so there is no need to take the risk of surgery, and in case the tumor grows faster, it is too late to operate again. For patients with poor psychological tolerance and heavy psychological burden, surgery can also be considered, because, the psychological damage brought by no surgery may be greater. After all, cancer is invasive and invades the surrounding organs, resulting in high disability rate, which can seriously affect the quality of life of patients. Of course, for patients who grow in the gland, have no lymph node metastasis and have good follow-up, it is not bad to choose close follow-up and conservative treatment. If the tumor progresses, surgery will be performed, and if not, long-term conservative treatment will be performed. In conclusion, the ultimate goal is to maximize patient benefit. Whether surgery for microscopic thyroid cancer is overtreatment may be debated for some time. Regardless of the choice of surgical or non-surgical treatment, it is very important to communicate with the specialist.