The need for surgery for the 4 categories of thyroid nodules needs to be determined based on symptoms as well as biopsy results. Generally speaking, benign nodules do not require immediate surgery. If benign nodules lead to compression symptoms or increase significantly in size during follow-up, timely surgery is usually required, and malignant nodules require immediate surgical treatment. Thyroid nodules are categorized into 4A, 4B and 4C, with 4A having a malignant risk of 2% to 10%, 4B having a malignant risk of 10% to 50%, and 4C having a malignant risk of 50% to 90%. 4A has a lower risk of malignancy and does not require immediate surgery, but can be monitored by regular follow up visits. 4B and 4C nodules usually require a fine-needle aspiration biopsy to determine the benign or malignant nature of the nodule. If the puncture is benign, it can be observed temporarily with regular follow-up thyroid ultrasound. If the diameter of the nodule increases significantly during the follow-up period, repeat cytology or surgical pathology is usually required to determine the benign or malignant nature of the nodule. For malignant nodules, immediate surgery is usually required. In addition, for large thyroid nodules that cause symptoms such as dyspnea, dysphagia, and other symptoms that compress the trachea and esophagus, timely surgery is also required. The 4 categories of thyroid nodules require prompt hospitalization and treatment under the guidance of a doctor.