Grade IV thyroid nodules have the possibility of being benign. Grade 4 thyroid nodules are classified as 4A, 4B, and 4C. The likelihood of 4A malignancy is about 30%; 4B malignancy is about 60%; and 4C malignancy is about 90%. Therefore, thyroid nodules grade IV have the possibility of being benign. Generally, thyroid nodules with grade 4 are considered to have the possibility of malignancy, and the surgeon recommends surgery. If the patient really does not want to have surgery, he or she can choose to review the thyroid ultrasound regularly, and it is recommended to review the thyroid ultrasound once every 3-6 months, or perform a thyroid puncture biopsy to clarify the nature of the thyroid nodules and decide on further treatment based on the results. If it is malignant, surgery will be performed to remove it; if it is benign, regular review will be sufficient. Most of the thyroid cancer is papillary thyroid cancer and the prognosis is very good.