Objective: To summarize the experience in diagnosis and treatment of nodular goiter with thyroid carcinoma. Methods: The clinical data of 185 patients with nodular goiter and concomitant thyroid carcinoma who underwent surgical treatment from January 2007 to December 2012, and their diagnoses were confirmed by pathological examination, were retrospectively analyzed. Results: During that period, among a total of 1 657 patients with nodular goiter who received surgical treatment, 185 cases (11.16%) had concomitant thyroid cancer, of whom, 158 cases (85.4%) were papillary carcinoma, 17 cases (9.2%) were follicular carcinoma, 9 cases (4.9%) were the mixed form, and one case (0.5%) was undifferentiated carcinoma. The incidence of calcification in patients with nodular goiter and concomitant thyroid cancer was significantly higher than that in those with simple nodular goiter (χ2=130.16, P=0.00), and the incidence of cancer in patients with microcalcifications (gravel-like calcifications) was significantly higher than that in those with macrocalcifications (χ2=91.49, P=0.00). All patients underwent intraoperative frozen section assessment (except 12 cases in whom the diagnosis was recently confirmed at another hospital), and then underwent different surgical procedures of varying scopes according to patients’ conditions, and all of them were prescribed lifelong thyroxine therapy after surgery. Conclusion: Well differentiated papillary carcinoma is the most frequent type of thyroid cancer with concomitant nodular goiter; aggressive surgical treatment should be performed for patients who have nodular goiters with calcification and especially with microcalcification; intraoperative fast pathological examination of the nodular goiter should be performed, as this is helpful in the selection of the appropriate surgical approach.