Thyroid nodules are a frequent problem for clinicians, and it has been estimated that thyroid nodules can occur in about 4% of adults. There are benign and malignant thyroid nodules. Benign nodules include nodular goiter and thyroid adenomas, while malignant nodules include thyroid carcinoma, thyroid lymphoma, and metastases. Although malignant lesions are uncommon, they are difficult to identify preoperatively, and the most important thing is how to avoid missing the cancer. The incidence of histologically microscopic malignant tumors in the thyroid gland can be as high as 17%, as reported by autopsy materials. Clinically, the incidence of thyroid cancer is 39 cases per million people per year (3.9 per 100,000 population). The thyroid gland is located in the neck below the thyroid cartilage, on both sides of the trachea, and is shaped like a butterfly, like a shield nail, hence the name thyroid. The thyroid gland is divided into two lobes, the right and left, and the isthmus. The right and left lobes are located on both sides of the lower part of the larynx and the upper part of the organ. The upper end is from the midpoint of the thyroid cartilage, the lower end to the 6th tracheal cartilage ring, and sometimes up to the superior sternal fossa or behind the sternum. Nodular goiter is a type of simple goiter, which mostly evolves from diffuse goiter and belongs to simple goiter. The main causes of the disease are as follows: 1. Iodine deficiency: It is one of the main causes of endemic goiter. The iodine content of soil, water and food in endemic areas is inversely proportional to the incidence of goiter, and the fact that iodized salt can prevent goiter can prove that iodine deficiency is an important cause of goiter. In addition, an increase in the body’s need for thyroid hormones can cause relative iodine deficiency, such as during growth and development, pregnancy, breastfeeding, cold, infection, trauma and mental stimulation, which can aggravate or induce goiter. 2. Goiter-causing substances: food of the turnip family contains thiourea goiter-causing substances, and soybeans and cabbage also contain certain substances that can prevent the synthesis of thyroid hormones and cause goiter. The content of minerals such as calcium, magnesium and zinc in soil and drinking water are also related to the occurrence of goiter. Some endemic areas also lack the above-mentioned elements in addition to iodine, and there are also areas where the incidence of goiter is directly proportional to the hardness of drinking water. Drugs such as potassium thiocyanide, potassium perchlorate, para-aminosalicylic acid, thiouracil, sulfonamides, pautazone, colchicine, etc., can hinder the synthesis and release of thyroxine, thus causing goiter. 3. Hormone synthesis disorder: The causative factor of familial goiter lies in hereditary enzyme defects that cause hormone synthesis disorder, such as lack of peroxidase and deiodinase, which affect the synthesis of thyroxine, or lack of hydrolase, which makes it difficult to separate and release thyroid hormone from thyroglobulin into the blood, all of which can lead to goiter. This congenital defect belongs to recessive inheritance. 4. High iodine: It is rare and can be endemic or sporadically distributed. The pathogenesis is that excessive intake of iodine leads to over-occupation of the functional genes of TPO, which affects tyrosine iodination, the organic process of iodine is blocked, and the thyroid gland is compensated for enlargement. 5. Gene mutations: Such abnormalities include point mutations in exon 10 of the thyroglobulin gene, etc. Clinical manifestations The number of females with nodular goiter is higher than that of males. It usually occurs in adolescence and in endemic areas is often seen at school entry age. Goiter varies in size and shape. Initially, they are diffusely enlarged and often symmetrical on both sides; later, when nodules are formed, they are often asymmetrical bilaterally. Nodular goiter may be accompanied by cystic changes, and if complicated by intracapsular hemorrhage, the nodules may enlarge rapidly and cause pain in a short period of time. The surface of the gland is usually flat and soft; the gland moves up and down with the larynx and trachea during swallowing. Nodular goiter usually does not show functional changes and the patient’s basal metabolic rate is normal; however, when the nodule is large, it may compress the trachea, esophagus, blood vessels, and nerves and cause corresponding symptoms. Treatment of the disease Most goiters in adolescence can subside on their own. For goiter caused by iodine deficiency, iodide is rarely used nowadays. Instead, moderate amounts of thyroid hormone preparations are used to suppress excessive endogenous TSH secretion and supplement the deficiency of endogenous thyroid hormones for the purpose of relieving goiter, which can be applied to goiter caused by various etiologies, especially when the pathological changes are in the process of occurring before gelatinous goiter, which can have significant effects. Taking too much iodide can lead to disorders of thyroid function. It is naturally very useful to be able to identify goitre-causing substances and avoid them. 1), thyroid hormone: the common amount of dry thyroid preparation is 90-180mg per day, the course of treatment is usually 3-6 months, after stopping the drug, if there is a relapse can repeat the treatment to maintain the normal range of basal metabolic rate; levothyroxine (euthyroxine) for young patients in the early stage, can be treated with 100ug per day, the second month increased value of 150-200ug per day, serum TSH concentration measurement The degree of thyroid suppression can be estimated. In older patients or those with long-standing multinodular goiter, serum high-sensitivity TSH concentrations or TRH excitation tests should be performed before levothyroxine treatment to determine whether there is significant functional autonomy. If functional autonomy can be ruled out, levothyroxine may be used for treatment. The initial dose should not exceed 50ug per day and the dose should be gradually increased until the TSH value reaches the suppressive endpoint value. Nodular goiter does not respond as well to levothyroxine as diffuse goiter, but it does have some inhibitory effect on its further enlargement. 2) Iodine supplementation: Iodine supplementation should be reasonable for those who are simply iodine deficient, and varying degrees of retraction of the thyroid gland are seen after supplementation. The preparations available are compound iodine oral solution (Lugol liquid), potassium iodide, iodine oil intramuscular injection, etc. At present, they are rarely used. (3), Chinese medicine treatment: phlegm softening method: only see the thick neck, no special conscious symptoms belong to the gas and phlegm evidence, treatment should be phlegm softening, can use seaweed, kombu, zhebei, green skin, sea pumice, half summer, etc.. In addition, appropriate food such as seaweed, jellyfish skin and other seafood or iodine-rich food. 4), Indications for surgical treatment:? Compression of trachea, esophagus or laryngeal nerve causing clinical symptoms;? Post sternal goiter; ? Huge goiter affecting life and workers;? Nodular goiter with secondary hyperfunction;? Nodular goiter with suspected malignancy.