The need for surgery for thyroid nodules is related to the nature of the nodule. If a 22mmx20mm nodule is malignant, surgery is required, but a 22mmx20mm nodule is usually benign and can be observed and treated in conjunction with other symptoms. Generally, thyroid nodules larger than 2 cm in diameter should be examined for hyperthyroidism or other problems, and a fine needle aspiration biopsy should be performed to determine benignity or malignancy. Most thyroid cancers are less than 1cm in diameter, and malignant tumors of 22mmx20mm are relatively rare. Benign thyroid nodules should be followed up and observed. If tracheal pressure, breathing difficulty, swallowing discomfort occurs, or if the nodule exceeds 3-4 cm, malignant tendency is suspected and surgery is needed. A 22mmx20mm nodule without malignancy can be reviewed regularly, but when the nodule increases in size or malignancy affects health, surgery may be required as soon as possible.