There has been substantial changes to the methods of thyroid nodule management in the past decade, including new guidelines for performing thyroid ultrasound and biopsy. Genetic tests are now routinely used in some centers to aid in the diagnosis of thyroid nodules. Novel management options, including alcohol, laser, and radio frequency ablation have also gained popularity in the past few years. Considering the continuous increase in access to healthcare facilities in Saudi Arabia, we are expecting an upcoming epidemic of small incidentally detected thyroid nodules. This study highlights the major recent advancements in thyroid nodule management that are relevant to every Saudi physician and surgeon.