Thyroid nodules are very common in clinical practice, and with the widespread use of modern imaging techniques, the detection rate has increased significantly. The clinical incidence of thyroid nodules is generally about 5%, but if high-resolution ultrasound and CT examinations are performed, 30% to 50% of the population will have thyroid nodules. In the face of such a high incidence of thyroid nodules, clinical management should not be too “over”. Despite the high incidence and detection rate, about 95% of thyroid nodules are benign, so the key is to get the nature right. The method for determining thyroid nodules is not complicated or expensive. The first step is ultrasound, which is the best way to determine the number and size of thyroid nodules, as well as to make a preliminary determination of the benignity or malignancy of the nodules and to provide guidance for the next step in treatment. The most reliable diagnostic methods for the nature of thyroid nodules are fine needle aspiration biopsy and cytopathological examination. This test provides pathologic information about the lesion and is currently recognized as the “gold standard” for preoperative diagnosis of thyroid nodules, with a specificity and sensitivity of over 90%. The results of puncture diagnosis are malignant, suspected malignant, indeterminate, and benign. Clinical management should be guided by these results. Thyroid nuclear scan is another useful indicator in the diagnostic process of thyroid nodules, which was more frequently used in the past and is now less frequently used than before. Previously, the value of scanning cold nodules was considered important for the diagnosis of malignancy. It has been found in numerous studies that only 20% of cold nodules are malignant and 80% are benign. However, if the scan is of a hot nodule, it is basically certain to be benign. Therefore, at present, nuclear scan is used as a priority to determine the suspected “high-functioning nodules”. Modern treatment can cure most of the differentiated thyroid cancers except some undifferentiated cancers with high malignancy. The key is early diagnosis and standardized treatment, and regular follow-up after treatment. As with most malignant tumors, surgery is the preferred treatment for thyroid malignancy. Except for minimally differentiated thyroid cancer, total thyroidectomy is recommended for large tumor size, multicenter, and local and distant metastasis. This is not only for complete removal of the tumor, but also for future radioactive iodine treatment and follow-up. Total thyroidectomy followed by radioactive iodine therapy can give better results. Without total thyroidectomy, most of the radioactive iodine during radioiodine therapy will go to the remaining normal thyroid tissue and not to the tumor cells and tissues. In addition, theoretically, thyroglobulin will not be produced in the body after total excision, so if thyroglobulin is elevated during the follow-up, it means the tumor is recurring, and this test is very sensitive to determine whether the thyroid tumor is recurring. Of course, total thyroidectomy has certain risks, which may cause hypoparathyroidism and damage to the laryngeal nerve, so only qualified hospitals and experienced physicians can perform this procedure. Metastatic thyroid cancer that cannot be removed surgically or residual lesions after surgery can be treated with radioactive iodine. Thyroid cancer is basically ineffective to common radiotherapy (external radiation) and chemotherapy, unless the above mentioned methods are ineffective. Therefore, external radiation radiotherapy and chemotherapy are generally not recommended for thyroid cancer. However, thyroid lymphoma is very sensitive to radiotherapy and chemotherapy, so thyroid lymphoma does not need surgery, and radiotherapy and chemotherapy can be administered. Overtreatment is not advisable Nowadays, overtreatment of thyroid nodules is exceptionally serious, and many people undergo surgery without any evaluation once thyroid nodules are detected. The detection rate of thyroid nodules is very high, so surgery for all detected nodules would result in a huge over-medication and waste of medical resources, as well as unnecessary surgical trauma and pain for most patients. Of course, if a malignant nodule has been identified, or if there is a high degree of suspicion, aggressive surgery should be performed. Benign lesions with large nodules with symptoms of pressure or with aesthetic considerations may be operated. Most benign lesions, especially microscopic nodules detected by ultrasound, do not require surgical treatment and are best managed with regular follow-up. Patients should visit the hospital for regular checkups and decide on further management based on changes. Those who have low thyroid or high thyroid stimulating hormone (TSH) can be treated with thyroid hormone. If the nodules increase in size during follow-up, they can be re-examined by puncture; if they do not change or shrink, they can continue to be observed; if they grow faster or are clinically suspected to be malignant, they can also be operated.