Objective: To compare the diagnostic efficacy on benign and malignant thyroid nodules by TI-RADS and ultrasonic elastography alone or combined usage. Methods: Totally 203 cases of thyroid patients with 222 thyroid nodules were analyzed retrospectively. The benign and malignant thyroid nodules were evaluated by ultrasound, TI-RADS and elastography. The diagnostic efficacy of each of the three methods was compared according to the pathological results. Then the combined diagnostic performance of with the three methods were detected. Results: The mdiagnostic performance of TI-RADS(sensitivity 92.4%, specificity 85.4%) was almost the same as that of an experienced operator using ultrasound (sensitivity 90.8%,specificity 81.6%). The diagnostic performance of elastography was lower, the sensitivity was 72.3%, and the sensitivity was 87.4%. The TI-RADS combined elastography can improve diagnostic performance. Conclusions: In the diagnosis of benign and malignant thyroid nodules, TI-RADS method combined elastography technology can improve diagnostic efficiency.