Thyroid nodule 4b malignant after puncture, it is recommended to take surgical treatment, endocrine treatment and so on as early as possible under the guidance of doctors. 1. Surgical treatment: If it is clear that the thyroid nodule is malignant, it needs to be removed by surgery as soon as possible. After the surgery, attention should be paid to nursing care, and if the thyroid gland is completely removed, thyroid hormone should be used as prescribed by the doctor. 2. Endocrine therapy: endocrine therapy is thyroid stimulating hormone inhibition therapy, which is usually used as an adjuvant treatment for thyroid cancer and can effectively prevent recurrence or metastasis. Patients need to take drugs such as levothyroxine tablets or thyroxine tablets under doctor’s instruction. It should be noted that the treatment options for different types of thyroid cancer are not exactly the same, and some patients may be more suitable for radionuclide therapy, radiation therapy or targeted therapy. It is recommended to follow the doctor’s instructions for the specific treatment plan.