How to treat benign thyroid nodules

       In clinical practice, more patients come to the clinic because of benign thyroid nodules, and the treatment options are regular review, surgery or non-surgical treatment.  Regular review: Most benign nodules, which do not require specific treatment, can be followed up every 6-12 months; for suspicious nodules, the review period can be shortened. Clinical examination with hoarseness, difficulty in breathing/swallowing, fixed nodules, enlarged cervical lymph nodes, combined with neck ultrasound and, if necessary, five items of nail function, and puncture under ultrasound, most of them can meet the requirement of follow-up. If the nodule grows faster, which generally means that the nodule volume increases by more than 50%, or at least 2 meridians are found to increase by more than 20% (at least more than 2 mm) on ultrasound, indications for FNAB exist, which means fine needle aspiration under ultrasound guidance to clarify the pathology, or accompanied by malignant signs under ultrasound, surgery may be considered.  Surgical treatment: Surgery may be considered in the following cases: local pressure symptoms; combined hyperthyroidism and ineffective oral medication; retrosternal goiter; clinical consideration of malignancy or with high thyroid cancer factors; enlarged appearance, excessive ideological concerns, affecting normal life and strong request for surgery.  Due to the removal of all or part of the thyroid tissue, postoperative hypothyroidism mostly exists to varying degrees, and those with elevated thyroid peroxidase antibodies or thyroglobulin antibodies are more likely to develop hypothyroidism. Patients with total thyroidectomy should start taking oral eugenol immediately after surgery and should have their thyroid function monitored regularly to keep TSH levels in the normal range. For partial thyroidectomy, oral eugenol can be given after surgery, taking into account the thyroid function and the number of preserved glands; or if the thyroid function is rechecked one month after surgery and hypothyroidism occurs, eugenol replacement therapy should be given in time.  After surgery for benign thyroid nodules, TSH suppression therapy is not recommended to prevent nodule recurrence.  Non-surgical treatment: The routine use of oral eugenol suppression therapy for thyroid nodules is not recommended; for a subset of young patients with small multinodular goiter, TSH suppression therapy may be considered, but only if it is partially suppressed, that is, if the TSH value is between 0.4 and 0.6.  Iodine 131 is mainly used to treat thyroid nodules with autonomic uptake and associated hyperthyroidism. Iodine 131 can be considered for nodules with autonomic uptake of the thyroid gland without hyperthyroidism. It is also important to review the thyroid function once a year after treatment to prevent hypothyroidism. It is not indicated for women with pressure symptoms or retrosternal goiter and during pregnancy and lactation.  Others, such as ultrasound-guided percutaneous anhydrous alcohol injection, are effective for benign thyroid cysts or thyroid nodules containing large amounts of fluid. Percutaneous laser ablation and radiofrequency ablation are used to rule out the possibility of malignancy before treatment.