In online consultations and clinical work, patients often provide only a copy of their thyroid ultrasound results and ask the doctor to make a judgment on the benignity or malignancy of the nodules found by ultrasound, i.e. whether they are cancerous or not. It is important to understand that all medical imaging methods are not absolutely accurate in diagnosing disease, and ultrasound is no exception, as it only provides a probability of benign or malignant, and the final diagnosis requires further testing. Therefore, it is important for patients to be aware of this and to be advised of further investigations. In this article, we will provide information on the ways in which further tests can help to confirm a benign or malignant diagnosis, in order to help reduce the anxiety and nervousness of patients before diagnosis, as well as to guide them to the correct diagnosis and thus to timely and accurate treatment. Palpation of thyroid nodules Palpation of the thyroid gland is important in identifying benign and malignant thyroid nodules, and experienced thyroid surgeons can sometimes determine the benignity or malignancy of a nodule by palpation alone. A hard thyroid nodule, unclear margins, adhesions to the surrounding group, and inactivity suggest that the nodule may be malignant, and these findings combined with ultrasound results can basically determine that the nodule is malignant. Thyroid nuclide imaging Thyroid nuclide imaging is indicated for the evaluation of thyroid nodules larger than 1Cm in diameter. In single (or multiple) nodules with decreased serum TSH, thyroid iodine-131 or technetium-99m nuclide imaging can determine whether a nodule (or nodules) is a “hot nodule”, and “hot nodules “The vast majority of these nodules are benign and do not generally require a fine-needle crossing biopsy (FNA). Fine needle aspiration cytopathology (FNA) of thyroid nodules Fine needle aspiration cytopathology (FNA) of thyroid nodules is a direct puncture of the nodule with a fine needle (23 or 25 gauge needle) to extract the tissue cellular components of the nodule for pathological analysis. There are 2 types of puncture methods: one is direct puncture of nodules that can be palpated, and the second is ultrasound-guided puncture of nodules that cannot be palpated. FNA can be considered for thyroid nodules >1Cm in diameter, but it is not recommended for nodules with autonomic uptake of “hot nodules” confirmed by thyroid nuclide imaging and purely cystic nodules suggested by ultrasound, which are highly suspected to be malignant based on ultrasound images. Nodules with a diameter of <1Cm are not recommended for routine use, but should be used in the following cases: nodules with signs of malignancy on ultrasound, with abnormal ultrasound images of the lymph nodes in the neck, with a history of radiation exposure to the neck or radiation contamination in childhood, with a history or family history of thyroid cancer or thyroid cancer syndrome, with a positive 18F-FDG PET image, with abnormally high serum calcitonin levels, etc. FNA has a high diagnostic accuracy for benign lesions and papillary carcinoma, but cannot distinguish follicular carcinoma from follicular cell adenoma of the thyroid, and the final diagnosis depends on pathology after surgical resection. Follow-up diagnosis of thyroid nodules For most benign thyroid nodules, follow-up visits can be performed every 6-12 months. Follow-up intervals can be shortened for suspected malignant or malignant nodules that have not received treatment for the time being. The follow-up visit includes a history set and physical examination, and a review of the neck ultrasound. FNA should be performed if the nodes are significantly enlarged during follow-up, or if signs and symptoms suggestive of nodal malignancy (hoarseness, difficulty in breathing/swallowing, nodal fixation, enlarged lymph nodes in the neck, etc.) are present, and if ultrasound reveals an increase in nodal body volume of more than 50% or an increase in at least 2 diameter lines of more than 20%.