The treatments for grade IV thyroid nodules usually include regular review, medication, surgery, etc. It is recommended to treat the nodules under doctor’s guidance. Thyroid nodules grade IV are suspected malignant nodules with a malignancy risk of 2% to 90%, and are categorized into 4A, 4B, and 4C among the four grades, of which 4A is low suspected malignancy with a malignancy rate of 2% to 10%, 4B is medium suspected malignancy with a malignancy rate of 10% to 50%, and 4C is highly suspected malignancy with a malignancy rate of 50% to 90%. Puncture biopsy examination is recommended if necessary, and treatment options are selected based on the results of the puncture biopsy. If the result of the puncture biopsy is benign and asymptomatic thyroid nodules do not require special treatment, regular checkups will be sufficient; puncture biopsy for malignant thyroid nodules, or although benign but the nodules are large and produce pressure symptoms of thyroid nodules patients are recommended to undergo surgical resection treatment, and the use of levothyroxine substitution therapy will be required after the operation. Patients diagnosed with grade IV thyroid nodules should go to the hospital and ask the doctor to make a judgment and give a treatment plan based on the actual situation.