Objective：To explore the clinical paticularities and experiences in diagnosis and treatment of elderly patients with thyroid nodules. Methods：The clinical records of 144 patients more than 60 years old and 1412 young or middle-aged patients less than 60 years old with thyroid nodules admitted to Ruijin hospital were retrospectively analyzed. Results：Compared with the young or middle-aged patients, the elderly patients with thyroid nodules presented the following particularities: bilateral and multifocal lesions were the main manifestations and usually with larger nodules in diameters; compression symptoms and secondary hyperthyroidism were the main surgical indications; the reoperation rate was higher due to recurrence; the preoperative ASA score was poor; near-total thyroidectomy for bilateral and multifocal nodules under gereral anaesthesia was the main procedure; fat depositions were frequently found around the recurrent laryngeal and parathyroid glands during surgery, and the calcification rate of benign nodules was high (P>0.05). Except for higher incidence of transient hypocalcemia in the elderly patients, no significant difference was noted in terms of postoperative complication between the clderly and younger patients. Conclusions：In elderly patients with thyroid nodules, the surgical risks or complications can be reduced or avioded as long as their clincal particularities are fully understand and proper treatment is employed.