Thyroid 4b has nothing to do with the stage of cancer. A grade 4b thyroid nodule only indicates a higher possibility of malignancy, and further pathological examination is required to confirm the diagnosis of cancer. Ultrasound examination of thyroid nodules is classified into five levels according to TI-RADS, the higher the level, the higher the possibility of malignancy. A fine needle aspiration biopsy should be done to determine whether the nodule is malignant through pathological examination, or the nodule can be surgically removed first and pathological examination can be done during the operation to achieve early detection and treatment. Because for early diagnosed thyroid cancer, surgical treatment is effective, but regular follow-up and observation are needed after surgery to monitor the changes of thyroid function. In contrast, surgery should also be chosen for benign thyroid nodules with significant tracheal compression. For patients with negative pathology of thyroid nodules, regular follow-up ultrasound is required at 3-6 months to observe changes in the nodules.