Thyroid nodules (TNs) are common, found in up to 50% of individuals, with most being benign but some malignant. Accurate diagnosis and management are crucial to rule out malignancy and determine the need for surgery. This review discusses the evaluation, diagnosis, and treatment of TNs, emphasizing the role of ultrasound, fine-needle aspiration (FNA), and other diagnostic methods. TNs are typically detected during physical exams or imaging. Ultrasound is the preferred imaging method to assess whether a TN requires biopsy. FNA is crucial in deciding whether surgery or surveillance is necessary. Suspicious ultrasound features may require cytologic analysis to assess malignancy risk. Molecular tests show promise but are not yet fully validated. Management depends on FNA results and ultrasound characteristics, ranging from follow-up for low-risk cases to surgery for high-risk patients. Clinicians should assess each patient individually using current guidelines and a multidisciplinary approach. TNs are more common in women and increase with age, iron deficiency, and radiation history. Risk factors include age, gender, iodine levels, family history, and radiation exposure. TNs include colloid nodules, follicular adenomas, cysts, inflammatory nodules, and malignant nodules. Diagnosis involves medical history, physical exams, and imaging. Laboratory tests like TSH and calcitonin help assess thyroid function and cancer risk. Ultrasound is the primary imaging tool, with specific features indicating malignancy. TI-RADS classification helps determine the risk of malignancy. FNA is the gold standard for diagnosis, with results categorized using the Bethesda system. Indeterminate results may require further testing or surgery. Management varies based on risk, with follow-up for low-risk and surgery for high-risk cases. Alternative treatments include radioactive iodine, anti-thyroid drugs, and minimally invasive procedures like RFA or ethanol injection. Thyroid artery embolization can reduce nodule size. The review emphasizes the need for evidence-based, individualized care to balance between over- and under-treatment. Future research should focus on improving diagnostic algorithms and testing for indeterminate cases.Thyroid nodules (TNs) are common, found in up to 50% of individuals, with most being benign but some malignant. Accurate diagnosis and management are crucial to rule out malignancy and determine the need for surgery. This review discusses the evaluation, diagnosis, and treatment of TNs, emphasizing the role of ultrasound, fine-needle aspiration (FNA), and other diagnostic methods. TNs are typically detected during physical exams or imaging. Ultrasound is the preferred imaging method to assess whether a TN requires biopsy. FNA is crucial in deciding whether surgery or surveillance is necessary. Suspicious ultrasound features may require cytologic analysis to assess malignancy risk. Molecular tests show promise but are not yet fully validated. Management depends on FNA results and ultrasound characteristics, ranging from follow-up for low-risk cases to surgery for high-risk patients. Clinicians should assess each patient individually using current guidelines and a multidisciplinary approach. TNs are more common in women and increase with age, iron deficiency, and radiation history. Risk factors include age, gender, iodine levels, family history, and radiation exposure. TNs include colloid nodules, follicular adenomas, cysts, inflammatory nodules, and malignant nodules. Diagnosis involves medical history, physical exams, and imaging. Laboratory tests like TSH and calcitonin help assess thyroid function and cancer risk. Ultrasound is the primary imaging tool, with specific features indicating malignancy. TI-RADS classification helps determine the risk of malignancy. FNA is the gold standard for diagnosis, with results categorized using the Bethesda system. Indeterminate results may require further testing or surgery. Management varies based on risk, with follow-up for low-risk and surgery for high-risk cases. Alternative treatments include radioactive iodine, anti-thyroid drugs, and minimally invasive procedures like RFA or ethanol injection. Thyroid artery embolization can reduce nodule size. The review emphasizes the need for evidence-based, individualized care to balance between over- and under-treatment. Future research should focus on improving diagnostic algorithms and testing for indeterminate cases.