ACR is thyroid nodules, TI-RADS 4 nodules have a greater likelihood of malignancy, it is recommended to perform a puncture biopsy to clarify the nature of the next step in the treatment. TI-RADS category 4 thyroid nodules indicate a higher likelihood of malignancy, with a 51% to 90% likelihood of malignancy in the thyroid gland. category 4 thyroid nodules may be the result of benign diseases such as Hashimoto’s thyroiditis and thyroid adenomas, or malignant tumors such as thyroid cancer. Follow-up, puncture biopsy, and surgery are options. If the nodule is malignant, radical surgery, 131 iodine radionuclide therapy, thyroxine administration and other comprehensive treatments are required. Asymptomatic nodules that do not require biopsy and are confirmed to be benign by puncture can be followed up for observation. Thyroid 4 nodules need to be treated according to the size and location of the nodule and the result of biopsy, etc. It is recommended that the patient should consult the doctor in time and follow the doctor’s instructions for treatment, and the medication should be used under the guidance of the doctor.