Thyroid 4b is a grade under thyroid ultrasound. Thyroid 4b, i.e., thyroid nodules with a high suspicion of thyroid cancer, usually requires puncture pathology before deciding on the next step of treatment, and the decision of whether to be conservative or surgical needs to be made under the guidance of a doctor. Thyroid nodules can be categorized into grades 1 to 6 according to the results of the ultrasound examination, ranging from mild to severe. Generally speaking grade 1 is normal thyroid, grade 6 is confirmed thyroid cancer and grade 4b is highly suspected thyroid cancer. Since the risk of malignancy for grade 4b is around 10% to 50%, thyroid puncture biopsy is preferred for definitive diagnosis. Thyroid puncture biopsy is the gold standard for defining the nature of the thyroid nodule preoperatively. If the pathological findings are malignant, or suspected malignant, surgery is required. If the pathology is benign, the size of the thyroid nodule should be observed, and if it does not affect other surrounding tissues, close follow-up and regular rechecks are recommended. Thyroid stage 4b patients, need to follow the doctor’s instructions for further examination and treatment, do not make their own decisions, so as not to delay the condition.