ABSTRACT Objective To evaluate the diagnostic value of single two-dimensional ultrasound, elastography, contrast-enhanced ultrasound and their combined examinations in Hashimoto’s thyroiditis with benign and malignant nodules.Methods Two-dimensional ultrasound, elastography, and contrast-enhanced ultrasound were performed on 54 nodules in 44 patients with Hashimoto’s thyroiditis. The ultrasound diagnosis results were compared with the pathological results and analyzed, and the two-dimensional ultrasound, elastography, and ultrasound were calculated and compared. The diagnostic efficiency of angiography and the combination of the three for Hashimoto's thyroiditis with benign and malignant nodules.Results Using TI-RADS 4 and 5 as the criteria for the diagnosis of malignant nodules by two-dimensional ultrasound, the sensitivity, specificity and accuracy of two-dimensional ultrasound are 50.0%, 82.5%, and 74.0%, respectively; measured by shear wave elastography The Young’s modulus value of nodule ≥ 46.1 kPa is used as a predictor of malignant nodules. The diagnostic sensitivity, specificity and accuracy of elastography are 57.1%, 85.0%, and 77.7%, respectively. The low heterogeneity enhancement is The diagnostic criteria for malignant nodules, the diagnostic sensitivity, specificity, and accuracy of contrast-enhanced ultrasound were 64.3%, 80.0%, and 75.9%, respectively; the diagnostic sensitivity, specificity, and accuracy of the three combined examinations were 85.7%, 95.0, respectively %, 92.5%. The accuracy of the combined inspection of the three was higher than that of the single inspection, and the differences were all statistically significant (all P<0.05).Conclusion TMultimodal (two-dimensional ultrasound, elastography, contrast-enhanced ultrasound) combined ultrasound examination is more valuable than a single examination in the diagnosis of Hashimoto's thyroiditis with benign and malignant nodules, and it is worthy of further promotion and application.