With the increasing popularity of medical checkups and the growing awareness of people about their health, the detection rate of thyroid nodules is now on the rise. Once thyroid nodules are detected, many patients are very concerned about the benignity and malignancy of thyroid nodules and the countermeasures for treatment. Because of the non-invasive nature of ultrasound and its increasing sensitivity, ultrasound is currently used as the test of choice for the diagnosis of thyroid nodules. Its accuracy is higher than that of CT and MRI and nuclear scans. Ultrasound can detect nodules several millimeters in size, which may not be possible with other tests. Generally ultrasound should consider these nodules malignant if it finds tiny gravel-like calcifications or abnormal nodule morphology, disproportionate longitudinal/transverse ratio or abnormally rich blood supply in the nodule or gross nodule border without acoustic halo. However, after all, ultrasound is an indirect diagnostic method and is influenced by subjective factors such as the ultrasonographer’s experience. Therefore, for malignant nodules suspected by ultrasound, it is best to recommend a puncture test. Some patients have some concerns about the puncture of thyroid nodules, fearing that if the nodules are malignant, whether the puncture will cause the tumor cells to spread more quickly, or if the nodules are originally benign but become malignant after the puncture. The guidelines for the diagnosis of thyroid nodules in China also recommend nodal puncture. If puncture really has the above-mentioned side effects, it is impossible to promote it. Some patients are afraid of the pain associated with puncture. In fact, thyroid nodule puncture is very minimally invasive and generally does not cause harm to the body. It is important to emphasize that puncture of thyroid nodules is best recommended to be done under ultrasound positioning, especially for nodules of a few millimeters in size, as this will increase the accuracy of the puncture, otherwise blind puncture may result in misdiagnosis. If the puncture suspects or identifies a malignant thyroid nodule, immediate surgical treatment is recommended. If the puncture result is benign, since the thyroid gland is an endocrine organ and has the function of producing thyroid hormones, surgery may cause problems with hypothyroidism requiring lifelong medication or may face recurrence after surgery requiring multiple surgeries, so it is best to take appropriate treatment measures on a case-by-case basis. Since the likelihood of a benign nodule becoming malignant is about 4%, most patients can be followed up for life if the nodule does not change. However, if the nodule is found to be malignant or to have compression during the follow-up, surgery should still be considered.