There is no such thing as more benign or more malignant thyroid category 4a, but the risk of malignancy in thyroid nodules category 4a is 2% to 10%, with a low chance of malignancy and a high likelihood of being a benign nodule. Thyroid TI-RADS classification can help determine the risk of malignancy of thyroid nodules, the risk of malignancy of thyroid nodules category 4a is about 2% to 10%, it is recommended to perform a fine needle aspiration biopsy to clarify the benign and malignant nature of the thyroid nodules, and to further decide on the treatment. If they are benign, thyroid ultrasound and thyroid function need to be reviewed regularly, and if they are malignant, they should be surgically removed. Thyroid nodules category 4a should be seen in the hospital and treated under a doctor’s supervision.