INTRODUCTION: Thyroid nodules are a common clinical finding, affecting approximately 1% of men and 5% of women, with only 5% proving malignant. High-resolution ultrasonography detects nodules in up to 68% of screened individuals, particularly in women and the elderly. Thyroidectomy is indicated for both benign (e.g., nodular disease, hyperthyroidism, obstructive goiter) and malignant conditions (e.g., differentiated, medullary, or anaplastic thyroid cancer), as well as rare cases of thyroid lymphoma or metastatic disease. The aim of this study was discuss the indications for elective thyroid surgery and peri-surgical clinical strategy in patients with thyroid diseases. MATERIAL AND METHODS: A comprehensive literature review was conducted from October 2024 to April 2025, analyzing relevant publications published between June 2005 and January 2024, sourced from PubMed, Scopus, Web of Science, and the Cochrane Library. REVIEW AND DISSCUSION: Thyroid disorders encompass various conditions, including Graves' disease, hyperthyroidism, and thyrotoxicosis. Hypothyroidism manifests as subclinical or overt. Surgical indications for thyroidectomy include symptomatic nodules, indeterminate/Bethesda III-V cytology, malignancy (Bethesda VI), or compressive symptoms. Ultrasound-guided Fine-Needle Aspiration (FNA), based on nodule size and EU-TIRADS risk stratification, is pivotal for evaluation. Advanced aids in risk assessment. Surgical complications (hemorrhage, hypoparathyroidism, recurrence laryngeal nerve injury) require prompt management. Molecular testing refines indeterminate cytology diagnoses. Thyroidectomy is contraindicated in anaplastic cancer and/or high surgical risk cases. Postoperative monitoring for hypocalcemia, voice changes, and bleeding is essential. CONCLUSION: Resource constraints hinder widespread adoption of advanced thyroid diagnostics, creating challenges in optimal nodule management.