Thyroid calcification with ultrasound grade 4b is not necessarily cancerous, but it is very likely to be cancerous. Patients with thyroid nodules first need to undergo hematological thyroid function tests to rule out hyperthyroidism and hypothyroidism, and then undergo ultrasound examination of the thyroid gland and graded diagnosis to determine its benign or malignant nature. Thyroid nodules are graded from 0 to 6, with grade 4a representing less than 5% probability of malignancy, while grade 4b has a probability of cancer ranging from 5% to 50%. Patients need to undergo fine needle aspiration or even surgical resection, and send them for pathologic examination to rule out the possibility of malignancy.