Abstract：Objective To explore the diagnostic value of thyroid TI-RADS classification and elastography in thyroid malignant tumors. Methods A total of 612 thyroid nodules with 328 patients were retrospectively analyzed, who were treated and operated in our hospital from January 2019 to December 2020. The results of classification and hardness grading were summarized to verify the preoperative evaluation value of the standard for benign and malignant thyroid nodules. Results Among the 328 patients（612 nodules）, 161 patients（445 nodules）were malignant thyroid tumors, and in the rest 167 patients there were 72 benign thyroid tumors, 76 nodular goiter and 19 thyroiditis. The diagnosis accuracy rate of ultrasound was 91.7%（561/612）. Among the malignant nodules, papillary carcinoma is the most common, and most of them were hypoechoic, TI-RADS classification were 4b to 5, and the elasticity classification were Ⅲ to Ⅳ; 374 nodules growth vertically, and the aspect ratio were ≥1; in the 43 nodules, most of the irregular gravel-like calcifications were seen inside, which were classified as 4a～4b by TI-RADS, and grades Ⅲ~Ⅳ in elasticity. Conclusion Ultrasound TI-RADS grading and elastography can be used to evaluate thyroid nodules, and then the final risk assessment can be made according to the size of the nodules, the relationship with the capsule and lymph node metastasis. Ultrasound TI-RADS classification and elastography can be used as the first choice for the diagnosis of suspicious borderline thyroid nodules, and are worthy of clinical application.