Benign thyroid nodules are significantly common and occur in 50-60% of the population. Therefore, differentiation from malignant nodes and the choice of treatment tactics in some cases of benign pathology remain relevant. Despite advances in the clinical evaluation of thyroid nodules, methodological challenges exist due to empirically simplistic understandings of the nodular process. Different opinions on the pathogenesis of thyroid nodules and the history of the formation of the idea of the stages of nodules are considered. For the first time, based on natural principles and many years of ultrasound analysis of changes in benign thyroid ultrasound nodules, three stages of the nodular process were identified: Development, Wasting and Scarring. The stage of exhaustion has three substages: Initial, Moderate and Significant Wasting. The principles of stage-by-stage changes in nodules are explained and their ultrasound signs are shown.