There are many patients who visit us with thyroid nodules, and patients hear about a variety of treatments, but patients are most concerned about those conditions that require surgery. I will now discuss my views on the indications for surgery for thyroid nodules. There are many diseases that can cause thyroid nodules, including nodular goiter, adenoma, subxiphoiditis, Hashimoto’s disease, hyperthyroidism, and thyroid cancer. Among them, adenoma and thyroid cancer are absolute indications for surgery, while the other nodules, thyroiditis and hyperthyroidism are relative indications for surgery. Which of these relative indications require active surgery, which can be treated medically, and which can be monitored? It depends on the disease. If the above-mentioned diseases are combined with tracheal compression, if the mass is huge and affects life, if the mass grows upward in the mediastinum, if the nodule is suspected to be malignant or has become malignant, or if the hyperthyroidism cannot be treated with radioactive iodine for other reasons, active surgical treatment should be performed. Among the above cases, nodules suspected of malignancy or already malignant are the most difficult to determine in clinical work. Even if experienced doctors combine imaging and laboratory tests, the correct diagnosis rate is about 80%. The other 20% depends on the patient’s attitude towards the disease. If the patient is very afraid of the disease and it affects work and life, surgery should be performed to relieve the physical and mental impact on the patient, if the patient is calm, observation can be made and treatment can be decided after a clear diagnosis. For patients who can be clearly diagnosed as benign nodules, as long as there is no pressure and it does not affect work and life, they can be treated non-operatively or observed. At present, the better medical institutions in China, with the accumulation of experience of specialized doctors, advances in imaging, and the development of pathological diagnosis. The preoperative correct diagnosis rate of thyroid disease can be around 80%, but still can not meet the requirements of patients. It will take some time to train doctors and develop more accurate diagnostic techniques to cope with the increasing number of patients with thyroid nodules.