Objective To analyze and compare the diagnostic value of Q-BoxTM Trace and Q-BoxTM shear wave elastography measurement methods for benign and malignant ACR TI-RADS 4 thyroid nodules.Methods Seventy-nine patients with ultrasound-reported ACR TI-RADS classification 4 thyroid nodules，with a total of 95 nodules were examined by SWE. Young 's modulus maximum, minimum, and standard deviation of the entire nodule were measured using a traced interest program (i.e., Q-BoxTM Trace); Emax, Emean, and Esd of the local nodule were measured using a circular region of interest program with a diameter of 2 mm (i.e., Q-BoxTM), and receiver operating characteristic curves were plotted to analyze the diagnostic efficacy of the two methods for thyroid nodules.Bland-Altman plots were used to calculate the number of points beyond the 95% confidence interval，and SPSS statistical software was applied to compare the intra-group correlation coefficients and to compare the inter- and intra-evaluator repeatability differences between the two methods.Results Malignant nodules Emax, Emean, and Esd measured by Q-BoxTM and Q-BoxTM Trace were greater than benign nodules, and the differences were statistically significant （P＜0.05）. ROC curve analysis showed that the area under the curve , sensitivity, and specificity of Emax measured by Q-BoxTM Trace for the diagnosis of malignant thyroid nodules were 0.786, 75.0%, and 76.9%, respectively, and the AUC, sensitivity, and specificity of Q-BoxTM were 0.699, 72.9%, and 66.7%, respectively, and there was a significant difference between the two methods （P＜0.05）. SPSS statistics showed that the coefficient of variation of Q-BoxTM Trace between operator A，operator B and inter-operator were lower than those of Q-BoxTM, and the difference was statistically significant（P＜0.05）;The intra-operator and inter-operator the ICCs of two measurement methods were ＞0.96, and the ICCs of Q-BoxTM Trace were higher than those of Q-BoxTM, and the difference was statistically significant（P＜0.05）. The results of Bland-Altman plots showed that the number of points outside the 95% confidence interval for Q-BoxTM Trace and Q-BoxTM were 2% and 6%，respectively, indicating that the repeatability and consistency of Q-BoxTM Trace were superior to Q-BoxTM Trace.Conclusion Both Q-BoxTM and Q-BoxTM Trace have certain clinical value in the diagnosis of benign and malignant ACR TI-RADS classification 4 thyroid nodules.but Q-BoxTM Trace has higher repeatability and less variability, suggesting that it may be a standardized SWE measurement method that is less affected by external objective reasons.