The need for surgery for thyroid nodule category 4A is determined primarily by the specifics of the disease. Thyroid nodules category 4A have a certain tendency to be malignant, and if they are diagnosed as malignant or if they show symptoms of compression, surgery is usually required. If a category 4A thyroid nodule is benign and there are no other uncomfortable symptoms, surgery is usually not needed and regular follow-up thyroid ultrasound is sufficient. Category 4A nodules are of low suspicion of malignancy, with a 2% to 10% malignancy rate. 4A nodules >15mm, puncture is recommended; for multifocal 4A nodules, or immediately adjacent to the peritoneum, trachea, or laryngeal nerves, puncture can be considered at >10mm; unifocal 4A nodules ≤10mm can be followed up if they are not immediately adjacent to the peritoneum, trachea, or laryngeal nerves. Patients with category 4A thyroid nodules should consult a medical professional for diagnosis and treatment.