Most patients with thyroid nodules do not require surgery because most of them are benign lesions, but 5-10% of them may be malignant nodules, or what we call thyroid cancer or other malignant tumors, and these patients need timely surgical treatment. For benign, large and symptomatic nodules with tracheal and local compression, surgical excision is feasible. For most asymptomatic benign nodules, regular ultrasound follow-up is sufficient. Is levothyroxine (L-T4) treatment indicated? L-T4 does not reduce the size of most thyroid nodules. In iodine-rich areas, 17-25% of solid thyroid nodules shrink after T4 suppression (>50%). Because T4 suppression therapy can cause subclinical hyperthyroidism and patients treated are at increased risk of atrial fibrillation and reduced bone mineral density, routine T4 suppression therapy is not recommended for most patients with nodular goiter and normal thyroid function. However, for some patients, such as young patients in iodine deficient areas, with a history of external exposure in childhood and growing nodular goiter, T4 therapy to achieve minimal suppression of TSH (e.g., <0.5 mU/L) may have some benefit. If TSH is already below normal, suppressive therapy is ineffective.