Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) combined with C-TIRADS classification in the diagnosis of benign and malignant thyroid nodules. Methods A total of 116 patients with 121 thyroid nodules who underwent ultrasound examination and contrast-enhanced ultrasound were selected for C-TIRADS classification and contrast-enhanced ultrasound evaluation, using surgical pathology findings and fine-needle aspiration (FNA) biopsy pathology as the gold standard. Receiver operator characteristic (ROC) curve was used to compare the diagnostic performance of C-TIRADS, CEUS and a combination of both methods. Results ROC curve showed that AUC of C-TIRADS, CEUS and the combination of both methods were 0.820, 0.824 and 0.886 respectively. The optimal truncation values in differentiating benign and malignant nodules were 4C, 2points and 4C. The area under the ROC of CEUS combined with C-TIRADS classification was higher than those of C-TIRADS classification and CEUS scoring, the difference was statistically significant (Z=3.183，P<0.01；Z=2.070，P=0.038)．Conclusion CEUS has revised value for C-TIRADS 4 nodules. CEUS combined with C-TIRADS classification can significantly improve the diagnostic performance of benign and malignant thyroid nodules.