Goiter includes carcinoma, adenoma, goiter, hyperthyroidism, subacute and lymphatic follicular thyroiditis. Sometimes several diseases are mixed together. It is easy to distinguish between benign and malignant typical thyroid tumors clinically, but intra-glandular thyroid carcinoma is especially like well differentiated follicular carcinoma, which is very similar to adenoma, and it is obviously difficult to distinguish them clinically alone, and other ancillary tests are needed. A few thyroid nodules, subacute thyroiditis, lymphatic follicular thyroiditis, and Riedel’s thyroiditis are also quite difficult to distinguish from thyroid cancer. Because of the different treatments, careful history and physical examination are necessary to grasp the main points and then combine them with relevant tests for a comprehensive analysis to arrive at a more reliable clinical diagnosis. It is recommended that abnormal goiter or nodule should first be differentiated from tumor, and medical history and physical examination are often very helpful for differential diagnosis. A physical examination reveals diffuse enlargement of the thyroid gland or mild nodular swelling, and a 131I scan and iodine uptake rate test are usually sufficient to confirm the diagnosis. If there is a history of upper respiratory tract infection, then blood sedimentation, protein electrophoresis, and 131I tests should be performed to confirm the diagnosis, but it is important to emphasize that the tests should be done in a timely manner, otherwise the diagnosis will be lost. If a middle-aged woman has nodular enlargement of the thyroid gland with mild hyper- or hypothyroidism, some patients have neurosis; the thyroid gland is obviously enlarged, the two lobes may be asymmetrical, the surface of the gland has multiple hemispherical protrusions, and sometimes the cone lobe is also enlarged; the entire thyroid gland resembles an old-fashioned pencil holder, with clear borders and well-defined contours; its texture is solid and elastic; the cervical lymph nodes are not enlarged, so it should be considered as The diagnosis of lymphatic follicular thyroiditis (also known as Hashimoto’s thyroiditis) can be confirmed by radioimmunoassay for TGA, MCA, T3, T4, TSH, etc. and, if necessary, cytology by fine needle aspiration. If the patient has a history of thyroid nodules for many years, the disease is slow, the symptoms are not obvious, the cervical lymph nodes are not large, and the patient is from a goiter endemic area and the relevant tests are within normal limits, then it is more likely that the patient has thyroid nodules. If some of the nodules increase rapidly in size in a short period of time, the possibility of malignancy should be considered. In the case of older women, the thyroid gland, although not large, has a hard texture, poorly defined borders, is closely fixed to the trachea, and sometimes even has symptoms of respiratory compression, to be considered a mucocele (Reidel’s thyroiditis). However, to exclude cancer, surgical exploration is still valuable. A total thyroidectomy is not necessary once a non-cancerous tumor is diagnosed intraoperatively. The isthmus of the thyroid can be removed to relieve respiratory compression symptoms. After the initial exclusion of non-cancerous thyroid disorders, the benignity and malignancy of the tumor should be determined. Age is generally said to be an important reference factor. Younger ones have a greater proportion of malignant isolated thyroid nodules than adults, and 10% to 50% of individual thyroid nodules in patients under 15 years of age are malignant, but all are well-differentiated thyroid cancers. The incidence of thyroid cancer is also high in middle-aged and elderly people, especially in undifferentiated carcinoma mostly above 60 years of age. Gender is also closely related to various pathological types of thyroid cancer, among which papillary carcinoma is particularly prevalent in young women Radionuclide examination Radionuclide examination can clarify the morphology and location of the thyroid gland as well as the function of the thyroid gland and thyroid masses, so this examination has become a routine tool for diagnosing thyroid disease. Thyroid nodules are generally classified into 4 categories based on their function of 131I or 99mTc absorption: hot nodules; warm nodules; cool nodules; and cold nodules. Generally, a single cold nodule is more likely to be malignant. According to the data from the Institute of Oncology of the Chinese Academy of Sciences, the cancer detection rate among cold nodules is 54.5%. X-rays are also required to examine the frontal and lateral cervical trachea in order to understand the extent of the tumor, the different calcified images and the relationship with the trachea and esophagus. Another important purpose of x-ray is to observe the relationship between the trachea and the thyroid gland, as large benign thyroid tumors or nodules often displace the trachea, but usually do not cause tracheal stenosis, although there are exceptions. Sometimes thyroid cysts, due to their small size, thin walls and recurrent small nodules, are easily missed on clinical examination, but ultrasound examination can often detect them and is valuable in guiding surgical treatment. A few thyroid cancers have extensive infiltration and metastasis in the neck, but it is not easy to determine the degree of carotid artery invasion clinically. Ultrasound examination can show how the blood vessels are compressed or surrounded by the cancer, and can further determine the patency of blood flow. These dynamic observations cannot be replaced by other examination methods. In addition fine needle puncture of small thyroid nodules can be guided by ultrasound. Of course, ultrasonography has its shortcomings, as lesions smaller than 1 cm are often not easily detected, the clarity of the image is not as good as that of CT, and there are difficulties in characterizing the lesion. However, this examination can still be used as an important part of the comprehensive diagnosis Fine needle aspiration cytology A commonly accepted diagnostic method at home and abroad is needle aspiration biopsy cytology (aspiration biopsy cytology, ABC), which overcomes the shortcomings of the traditional needle aspiration biopsy and is simpler to perform, without local anesthesia. Children can also be examined, and there is no risk of cancer cell dissemination or implantation except for a small amount of bleeding in the tissue. However, traditional needle aspiration biopsy should not be completely abandoned. For suspicious metastases in the neck, especially cystic foci, biopsy with a coarse needle aspiration can quickly obtain a pathological diagnosis, which is a simple and easy diagnostic method. In addition to the usual nuclear tests, radioimmunoassays such as T3, T4, TSH, etc. are sometimes required to determine whether there is hyperthyroidism. If lymphatic follicular thyroiditis is suspected, a thyroid antibody test can be of high diagnostic value; commonly used are thyroglobulin antibody (TGA) and microparticle antibody (MCA) tests. For patients with total thyroidectomy and long-term replacement therapy with thyroid tablets, it is best to measure T3, T4, TSH and TG regularly. However, there are two clinical manifestations of thyroid adenoma. In one case, it can be accompanied by hyperthyroidism, and a thyroid scan shows the adenoma as a hot nodule (radioisotope concentration). Some people call this condition toxic thyroid adenoma, which is due to the increased function of the adenoma and the production of large amounts of thyroid hormones, resulting in hyperthyroidism, mostly in women, mostly in the 30-40 range. The other condition is not associated with hyperthyroidism and the thyroid scan shows a warm or cold nodule (lower radioisotope distribution than normal thyroid tissue), which is not called a toxic thyroid adenoma, but a simple thyroid adenoma. Thyroid adenomas can be pathologically divided into many types, the common ones being follicular adenoma and papillary adenoma. Although thyroid surgery is a minor surgery, it can easily cause problems, so it is recommended to operate in a larger hospital. It is difficult to distinguish thyroid adenoma from thyroid cancer, especially in the early stage, and it is generally not advisable to remove the adenoma alone, but to perform subtotal or total excision of the affected lobe.