ABSTRACT Objective The purpose of this study was to investigate the value of a new model of shear wave elastography (SWE) combined with conventional ultrasound multi-parameter weighting method in the differential diagnosis of benign and malignant thyroid nodules. Methods A retrospective analysis was performed on 175 thyroid nodules in 168 patients with definite pathological findings and complete conventional ultrasound and SWE data from June 2021 to September 2022, among which 145 nodules in 138 consecutive patients were included in the modeling cohort and 30 nodules in 30 consecutive patients were included in the validation cohort. In this study, all thyroid nodules were confirmed by postoperative pathology or ultrasound-guided fine-needle aspiration cytology (US-FNAC). Single factor analysis was used to determine the risk factors of conventional ultrasound features and SWE parameters. Binary logistic regression analysis was used to screen independent risk factors, and the odds ratio (OR) of each risk factor was calculated. According to the OR values of relevant indicators, the total score of each nodule was calculated, the receiver operating characteristic curve (ROC) was drawn, the prediction model based on the weight of multiple parameters was established, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of the model. And validate in the validation queue. Results In SWE parameters, ROC showed that the AUC of maximum elastic modulus (0.813) was higher than the average elastic modulus (0.730), and the optimal critical point was 38.3kPa, which was the best parameter to distinguish thyroid benign and malignant nodules (P < 0.001). In conventional ultrasound parameters, aspect ratio≥1, solid component and echogenic foci were independent risk factors. According to the OR values of different parameters, the prediction model based on the weight of multiple parameters was obtained. The AUC of the model was 0.906, the 95% confidence interval was 0.850-0.961, the sensitivity was 87.4%, the specificity was 90.5%, the PPV was 95.7%, the NPV was 74.5%, and the accuracy was 88.0%. The AUC for the differentiation of benign and malignant thyroid nodules in the validation cohort was 0.918, 95% confidence interval 0.808-0.985, sensitivity 91.9%, specificity 75.0%, PPV 91.9%, NPV 75.0%, accuracy 87.0%. Conclusion The new model of SWE combined with conventional ultrasound multi-parameter weighting method is helpful to improve the application value of ultrasonic multimodal imaging technology in benign and malignant thyroid nodules, and provide a simple and economical selection strategy for clinical practice including US-FNAC.