Objectives To evaluate the diagnostic performance of conventional sonography and strain elastography in thyroid nodules with indeterminate cytologic（i.e. BethesdaⅢ/Ⅳ/Ⅴ）findings. Methods This retrospective analysis enrolled 135 nodules surgically treated at our hospital with indeterminate results on fine-needle aspiration (FNA) cytology. Ultrasound images of the 135 nodules were retrospectively analyzed.The elastogram was matched with an elasticity color scale and classified by amended 5-point scoring criteria.Differences in sonographic characteristic between the benign and malignant nodules were assessed.The diagnostic performance of conventional sonography and strain elastography in thyroid nodules with indeterminate cytology were investigated.Results A total of 112 nodules (83%) were malignant ; 23 (17%) were benign. The association of conventional sonographic features identified 107 of 112 thyroid cancers (sensitivity, 95.54%; specificity, 56.52%; accuracy, 88.89%;positive predictive value, 91.45% and negative predictive value,72.22% ), whereas the association of conventional sonographic features plus elastographic scores of ≥3 identified 110 of 112 thyroid cancers (sensitivity, 98.21%; specificity, 30.43%; accuracy, 86.67%;positive predictive value, 87.3% and negative predictive value,77.78% ).Conclusions Our data suggest that elastography could be a promising tool in the management of nodules with indeterminate cytologic findings. But the combination of conventional sonographic features and elastographic scores showed inferior diagnostic performances in predicting malignant nodules with indeterminate FNA cytology results in comparison with the association of conventional sonographic features alone.