Objective: To explore the efficacy of shear wave elastography (SWE) combined with thyroid imaging reporting and data system (ACR-TIRADS) in differentiating benign and malignant thyroid nodules. METHODS: A total of 129 patients with thyroid nodules (142 thyroid nodules) in ShuGuang Hospital were enrolled in this study. With the pathological results as the gold standard, each nodule was evaluated by TIRADS. The validity of SWE parameters was evaluated by ROCs. Using area under ROC curve (AUC) to compare the diagnostic performance of TIRADS alone and combined TIRADS with SWE. RESULTS: The AUC values of TIRADS and TIRADS+SWE alone were 0.885 (Accuracy 83.5% and 0.914 (Accuracy 83.9 %). However, compared with TIRADS, TIRADS + SWE score has higher specificity (75.9 % vs 89.4%) and positive predictive value (79.3 % vs 82.7%), respectively. Conclusion: Combination of SWE and TIRADS can improve the specificity of TIRADS in differentiating benign and malignant thyroid nodules.