Abstract： Objective To evaluate the clinical value of strain ratio of real-time elastosonography in the diffential diagnosis of thyroid nodules with coexistent chronic Hashimoto’s thyroiditis. Methods This research was conducted via analyzing the elasticity imaging of 186 Hashimoto’s thyroiditis patient with 231 nodules and calculating the stain ratio of each lesion to the same lateral thyroid tissue respectively to determine the benign and malignant diagnosis of nodules based on the cutoff point, 2.73.All the lesions were confirmed by surgery and pathologic examination. Results There were 60 malignant nodules and 171 benign ones in 231 Hashimoto’s thyroiditis with thyroid nodules. The median(upper and lower four digits) of SR of benign and malignant nodules was 3.11(5.08，1.89) and 1.59(2.17，1.15) (P<0.001). When the premier cutoff point was set to 2.73, the sensitivity, specificity, accuracy, PPV and NPV of were 60.00%（36/60）,86.55%(148/171), 79.65%(184/231) and 61.02%（36/59） respectively in differential diagnosis of benign and malignant nodules with Hashimoto’s thyroiditis.Conclution The stain ratio of real time ultrasound elastography put positive effects in the differentialsis of malignant and benign nodules with Hashimoto’s thyroiditis, which can be applied in clinic.