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The purpose of research was comparing the ultrasound (US) features and fine-needle aspiration cytology (FNAC) in detecting the thyroid nodules in clinical practice. A cross-sectional analytical study retrospectively reviewed the US and FNAC findings for a total of 170 thyroid nodules. The US features that we compared included echogenicity, calcifications, shape, halo and Doppler, between 2017 and 2018. Totally, 170 nodules of thyroid were studied, which contained 72 (42.4%) benign and 98 (57.6%) malignant thyroid nodules. The sonographic features were significantly associated with malignancy such as microcalcification (97.0%), hyperechogenicity (91.5%), wider than taller shape (98.0%), absent halo (90.9%) and positive Doppler (78.0%) (P < 0.01). The altogether accuracies of calcification, echogenicity, shape, halo, and Doppler were 0.96, 0.92, 0.97,0.82 and 0.82, respectively. Our data suggest that US features could be a good sonographic criterion for recommending FNA cytology with follow‐up thyroid sonography and FNA.