Purpose Meta-analysis was performed to compare elastosonography and routine ultrasonography in the diagnosis of thyroid nodules. Materials and Methods Extensive literature search of CNKI, Wanfang data, OVID, the Cochrane Library, PubMed and Embase from 1980 to 2013 was performed using elastosonography, ultrasonography and thyroid nodules as key words. Clinical trials utilizing elastosonograpy and routine ultrasonography were selected. The quality and heterogeneity were evaluated. Specificity and specificity were summarized to generate receiver operating characteristic curves. Results Fourteen studies were selected including 10 literature in Chinese and 4 in English. There was significant heterogeneity in the sensitivity. The sensitivity for routine ultrasound, elastosonography and two techniques combined was 0.82 (95%CI 0.79-0.85), 0.61 (95%CI 0.57-0.64) and 0.93 (95%CI 0.90-0.95), respectively;with specificity of 0.70 (95%CI 0.68-0.72), 0.84 (95%CI 0.82-0.86) and 0.69 (95%CI 0.67-0.72). The summery area under curve was 0.8549, 0.8925 and 0.9614, respectively. Conclusion Evaluation of thyroid nodules using elastosonography is more sensitive and specific than routine ultrasonography. Combining elastosonography and routine ultrasonography provides better diagnostic accuracy.