Thyroid nodules of grade 4A require surgical treatment if malignant, or regular review if benign. Ultrasound signs of thyroid nodules are graded by TI-RADS grading method, which is generally categorized into 1~6 grades, grade 1 no nodule, grade 2 benign nodule, grade 3 probable benign nodule, 4A low suspicion of malignancy, 4B moderately suspicious of malignancy, 4C high suspicion of malignancy, grade 5 highly suggestive of malignancy, and grade 6 malignant. 4A generally requires close observation and regular follow-up. 1. Nodes larger than 1cm: For 4A nodules larger than 1cm, it is recommended to perform puncture biopsy, if the pathology suspects or confirms malignant nodules, surgery is required. If the nodule is benign, it can be left untreated and reviewed regularly by ultrasound. 2. Nodules less than 1cm: it may not be suitable for puncture biopsy, close follow-up is needed, and ultrasound of the thyroid gland should be done every six months in order to find out whether there are symptoms of compression in the nodules at an early stage, and then puncture to determine whether surgical treatment is needed. Thyroid nodules of grade 4A need to be reviewed regularly to avoid delays.