Objective To explore the clinical value of real-time ultrasound elastography in the diagnosis of thyroid nodules, and to provide reference for the clinical diagnosis and treatment of patients with thyroid nodular lesions. Methods The clinical data of 62 patients with thyroid nodule occupying lesions were retrospectively analyzed.The results of real-time ultrasound elastography imaging and pathological diagnosis were compared, and the accuracy, sensitivity and specificity of real-time ultrasound elasticity imaging in the diagnosis of thyroid nodular lesions were analyzed. Results The patients with elastic grade 0, pathological examination showed follicular adenoma cystic degeneration; The patients with elastic gradeⅠ, pathological examination showed follicular hyperplastic nodules; The patients with elastic grade Ⅱ, pathological examination showed follicular gland tumor; The patients with elastic grade Ⅲ, pathological examination showed papillary adenocarcinoma; The patients with elastic grade Ⅳ, pathological examination showed papillary adenocarcinoma.In patients with elastic grade 0, 3 patients had proliferative nodules, and 5 cases were follicular adenomas.Among the patients with grade Ⅰ, 5 cases were proliferative nodules, 8 cases were follicular adenoma, 1 case of papillary adenocarcinoma; of grade Ⅱ patients, 6 cases of proliferative nodules, 14 cases of follicular adenoma, 2 cases of papillary adenocarcinoma.Among the patients with grade Ⅲ, 4 cases were follicular adenomas, and 6 cases were papillary adenocarcinomas.Among the patients with grade Ⅳ, 3 cases were follicular adenomas, 7 cases were papillary adenocarcinomas.The diagnostic accuracy of real-time ultrasound elastography was 93.5%, and the difference was not statistically significant(P>0.05). The sensitivity and specificity of real-time ultrasound elastography were 100.0% and 72.6%. Conclusion Real-time ultrasound elastography has high accuracy in the diagnosis of benign and malignant lesions of thyroid nodules, it is worthy of being widely promoted. Key words: Thyroid diseases; Ultrasonography, doppler, duplex; Diagnosis