Thyroid grade 4b for five or six years has the possibility of deterioration and it is advisable to consult a doctor. Thyroid grade 4b is a classification of thyroid nodules under ultrasound, this type is moderately suspected of malignancy and has a malignancy rate of 10% to 50%. Thyroid nodules 4b for five or six years are still at risk of malignancy. If there are signs of malignancy such as a sudden increase in size or the development of pressure symptoms, it is recommended that an ultrasound-guided puncture biopsy be performed in a timely manner to clarify the nature of the nodule. If malignant, surgery can be performed under the guidance of a doctor. In conclusion, grade 4b thyroid nodules carry the risk of deterioration and should be regularly reviewed and actively examined and treated under the guidance of a doctor.