Thyroid nodule 4b accompanied by lymph node metastasis may be thyroid cancer, which is more serious and requires timely treatment. Thyroid nodule 4b, should refer to TIRADS grade 4b, belongs to moderate suspected malignancy, the malignancy rate of the nodule is 10% to 50%, when accompanied by lymph node metastasis, it suggests a high risk of malignancy, may be thyroid cancer, and it is recommended to take timely surgical treatment. Thyroid cancer can be divided into follicular thyroid cancer, undifferentiated thyroid cancer, medullary thyroid cancer and so on, and the degree of malignancy of different types of tumors varies to some extent. It is recommended that patients should seek medical treatment in time, and take treatment as early as possible according to the specific conditions of the disease, so as to avoid delaying the condition.