Thyroid nodule 4b for five or six years has the potential to worsen, especially in patients with changes in the nodule during the five or six years, a family history of thyroid cancer, and a history of exposure to radioactive materials, and patients with thyroid nodules are advised to undergo regular review. According to the TI-RADS grading of thyroid nodules, thyroid nodule 4b is a moderately suspicious malignant nodule with a risk of malignancy of 10% to 50%. TI-RADS 4b persists for five or six years, during which time there is a higher risk of deterioration if the nodule changes more significantly, or in patients with a family history of thyroid cancer, or with a history of exposure to radioactive substances. If necessary, a thyroid puncture biopsy can be performed to determine the benign or malignant nature of the nodule, and surgery needs to be considered once malignancy is diagnosed. If the thyroid puncture biopsy determines that the nodule is benign, it is important to review the nodule regularly to help detect early malignant changes in the nodule. Patients diagnosed with thyroid nodule 4b should go to the hospital and ask the doctor to make a judgment on a case-by-case basis.