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Thyroid nodules has become a significant public health issue worldwide with a rapidly increasing prevalence. However, its association with outdoor air pollution remains poorly understood. We aim to investigate the relationship between six outdoor air pollutants (PM , PM , NO , SO , CO, and O ) and the risk of thyroid nodules. We utilized a database including 4,920,536 participants who attended the annual physical examinations in the Meinian HealthCare Screening Center in 157 Chinese cities in 2017. City-specific concentrations of six po