Hi, Good day. The decision of surgery is based on many factors. What is your age? What are the sizes of nodules? Do you have any voice change, shortness of breathing while lying down, or difficulty swallowing food? HAs the thyroid grown downwards or sideward compressing vital structures ? What is the ultrasound character of nodules and any suspcison on malignancy? What is your Thyroid function test like? All these questions need to be considered when we deal with a multi nodular goiter. Ideally you need a needle test. Now a days thyroid surgery is very safe especially when done by an experienced thyroid surgeon. However when the thyroid swelling become huge, the chances of surgical complications increase. In some countries they offer non surgical treatment of nodules like Laser. However, this is after ruling out cancer by needle tests. Again, non surgical treatment is not ideal for big thyroid swellings. Voice change can happen after surgery, but as I mentioned earlier, it is extremely rare now. Surgery has no role in hair loss or skin wrinkling etc. Please consult your endocrinologist and surgeon and discuss your concerns with them. They will discuss the pros and cons of any treatment and then you can decide. Regards Binu