Objective:To analyze the Chinese thyroid imaging reporting and data system (C-TIRADS) classification combined with ultrasonic shear wave elastography (SWE) and super microvascular imaging technology (SMI) in the diagnosis of benign and malignant thyroid nodules.Methods:Clinical data of 125 patients undergoing thyroid nodule surgery in the Department of Ultrasound Medicine, Shantou Central Hospital were retrospectively analyzed. There were 35 males and 90 females. The disease duration was (3.45±1.32) years, ranging from 3 months to 7 years; the age was (55.45±3.31) years old, ranging from 25 to 70 years old; the maximum diameter of the nodule is (12.13±5.76) mm, ranging from 5.0 to 42.9 mm. C-TIRADS classification, SWE, SMI and pathological diagnosis results of ultrasonic nodules in patients were analyzed. The diagnostic performance of C-TIRADS classification, SWE, SMI and combined diagnosis of malignant nodules were analyzed. SPSS 21.0 software was used to analyze the data, and the measurement data were consistent with the normal Statistical distribution, independent t test was performed for comparison between two groups; count data were expressed as rate (%), and χ2 test was used. Results:A total of 180 lesions were detected this time. According to pathological diagnosis, there were 114 benign nodules and 66 malignant nodules; the malignant percentage of C-TIRADS 4B nodules was the highest, reaching 72.00% (36/50) ; Emix of malignant nodules, Emax and Emean were (15.98±6.56) kPa, (84.22±24.23) kPa and (63.29±15.89) kPa respectively, which were significantly higher than those of benign nodules (13.56±4.68) kPa, (48.33±14.46) kPa and (37.32±12.63kPa) ( t=2.49, 8.76, 9.07, P<0.05) ; Type IV malignancy accounted for the highest proportion in SMI classification of thyroid nodules, which was 78.95%; the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the joint diagnosis were 94.64%, 92.85%, 94.64%, 42.85%, 90.16%, higher than the single C-TIRADS classification (89.65%, 75.00%, 89.65%, 37.50%, 80.55%), SMI (82.35%, 55.56%, 89.36%, 32.60%, 78.33%), and SWE diagnosis (81.08%, 56.00%, 90.22%, 28.57%, 77.22%). The difference was statistically significant ( P<0.05) . Conclusions:Compared with the diagnostic efficiency of SWE, SMI and C-TIRADS classification alone, the combined use of the three has higher diagnostic efficiency for benign and malignant thyroid nodules. The abuse of invasive procedures can be reduced or avoided.