Thyroid nodule 4a does not necessarily need surgery sooner or later, if it has been a benign nodule does not need surgery, if it turns into a malignant nodule need to take timely surgical treatment. Thyroid nodules are masses formed by localized abnormal proliferation of thyroid cells. It is graded according to TI-RADS, grade 4 represents suspected malignant nodules, which are categorized into 4a, 4b and 4c, among which 4a represents low suspected malignancy, with the chance of malignancy ranging from 2% to 10%, and it is recommended that puncture and pathological examination be performed as prescribed by the doctor if necessary, in order to further determine the nature of the nodule. If the nodule is benign, surgery is usually not needed, and regular thyroid ultrasound checkups are sufficient; if the nodule is malignant, surgical resection or other treatment is needed. Patients with thyroid nodule 4a are advised to follow the doctor’s instructions.