Thyroid nodules grade 4a usually do not resolve spontaneously and are usually treated conservatively or surgically depending on their benignity or malignancy. Thyroid ultrasound TIRADS grading is used to guide the diagnosis of thyroid nodules and can grade the risk of malignancy of thyroid nodules (grades 1-6).4a Risk of malignancy is 2%-10%. Thyroid nodules grade 4a can be biopsied by fine needle aspiration if necessary to understand the benign or malignant nature of the nodule. If the nodule is benign, it needs to be rechecked regularly, usually once every 6 months to 1 year; if it is malignant or if the nodule is large enough to produce pressure symptoms such as dyspnea and dysphagia, it needs to be treated surgically. Thyroid nodules grade 4a should be seen in the hospital and treated under a doctor’s supervision.