Some of the thyroid nodules in category 4B do not require surgery, most of those that do require surgery undergo elective or limited surgery, and only a small percentage require immediate surgery. The TI-RADS classification is a benign and malignant risk assessment of thyroid nodules based on imaging such as thyroid ultrasound, in which category 4B nodules are moderately suspected of malignancy, with a 10% to 50% likelihood of being malignant, i.e. thyroid cancer. Puncture is recommended for category 4B nodules if the nodule is >10mm; if the nodule is adjacent to the perineurium, trachea, or laryngeal reentrant nerve, or if the nodule is multifocal, then puncture may be considered at >5mm. Puncture biopsy benign asymptomatic can be followed up for observation; those with thyroid function abnormalities can be treated with drugs such as methimazole; those with compression symptoms can be treated with elective surgery or ablation. If the result of puncture is malignant, if it is differentiated thyroid cancer, elective surgery is feasible, and a small number of patients have undifferentiated thyroid cancer with high malignancy, which needs limited surgery. There are only a few life-threatening emergencies that require emergency surgery, i.e., immediate surgery, such as intratumoral hemorrhage of thyroid tumors, compression of the trachea, resulting in respiratory distress, and so on. Patients are advised to consult a specialist for further examination and treatment according to their condition.