Thyroid nodule grade 4b is still serious, indicating a possibility of malignancy of up to about 10-50%. According to the international TI-RADS grading principle, thyroid nodules are categorized into 6 grades, with the higher the classification level, the higher the likelihood of malignancy. Thyroid nodule grade 4 is subdivided into 4a, 4b and 4c, with category 4b nodules having a malignant potential of around 10-50%. If the ultrasound results determine that the thyroid nodule is classified as 4b, there may be obvious blood flow signals around the nodule tissue, accompanied by calcified foci, abnormal aspect ratio of the nodule, etc., and it is recommended that further puncture biopsy be performed to clarify the nature of the nodule. If the pathological examination of thyroid nodule grade 4b is benign and the lesion is large and causes compression symptoms, resection is recommended. If the pathological examination confirms malignant nodules, surgical treatment is required. After surgery, local radiotherapy or chemotherapy, etc. will be administered according to the pathological staging to prevent tumor recurrence or metastasis. If the thyroid nodule is classified as grade 4b after examination, further examination should be carried out in time, and treatment should be carried out according to the doctor’s instructions, so as not to take it lightly, so as not to cause delay in the condition.