In general, there is no saying that “thyroid 4a will become cancerous in a few years”, thyroid 4a refers to the thyroid nodule graded as TI-RADS 4a, which has certain malignant potential, and it is recommended to further carry out thyroid puncture examination. 1. Thyroid nodule is a very common clinical lesion nowadays. According to the size, shape and boundary of thyroid nodule under color ultrasound, thyroid nodule is artificially classified into 6 categories. 1 category is negative, 2 category is definite benign nodule, 3 category is probable benign nodule, 4 category is suspected malignant nodule, 5 category is definite malignant nodule, and 6 category is biopsy-confirmed malignant nodule. 2. Thyroid category 4 nodules are subdivided into 4a, 4b and 4c. Category 4a nodules represent patients with a 2%-10% likelihood of malignancy of the thyroid nodule; category 4b nodules have a malignancy likelihood of 10%-50%, and category 4c nodules have a malignancy likelihood of 50%-90%. However, the benign or malignant nature of the tumor needs to be further clarified by puncture biopsy. 3. For grade 4a thyroid nodules, further fine needle aspiration of the thyroid gland is recommended to clarify the diagnosis. If the test result is benign, regular and close review is recommended; if the test result is malignant, surgery for radical treatment of thyroid nodules is required. If grade 4a thyroid nodules are found, it is recommended to consult a doctor as soon as possible to clarify the nature of the nodules so as to avoid delaying the condition.