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Introduction Health disparity due to socioeconomic status/ethnicity is a well-known issue. Research directed at evaluating these differences has not always found significant differences, Ahmadi et al 2017, did not show effects of insurance or ethnicity on thyroid cancer outcomes of Hispanic patients in San Antonio. This study focused on identifying the ultrasound characteristics of Hispanic vs non-Hispanic patients; evaluating which characteristics are associated with more aggressive papillary thyroid cancer (PTC) in Hispanic patients compared to non-Hispanic patients. Methods This is a retrospective case-control single center study at University Hospital System at San Antonio, Texas. A total of 800 electronic medical records were reviewed between 2015 to 2019, by comparing ultrasound characteristic of thyroid nodules and final pathology in Hispanic vs non-Hispanic patients. We included patients 21 years of age or older, who had a thyroid ultrasound, at least one fine needle aspiration (FNA), thyroidectomy and final surgical pathology consistent with PTC. Those excluded were either missing data or had other than PTC pathology. Ultrasound images were personally reviewed and characterized based on the American Thyroid Association® (ATA) 2015 Guidelines, assessing composition, echogenicity, microcalcification, taller than wider, margins, and extrathyroidal extension. Results A total of 175 patients met the inclusion criteria, for which 106 were Hispanic and 69 were Non-Hispanic, 82% female (n=143) and 18% male (n=32). In the Hispanic group 31.8% (n=34) were uninsured compared to 51.5% (n=36) of non-Hispanic patients. However, "highly suspicious" characteristics in the Hispanic group compared to non-Hispanic showed a difference with a p-value of 0.05. Those classified as "intermediate suspicion" were 38.9% in the Hispanic subjects compared to 35.8% in non-Hispanic. Multi-focal PTC vs unifocal in Hispanic population compared to non-Hispanic population utilizing chi square test analysis showed a difference with a p-value of 0.002. Conclusion There is a statistically significant difference between the "highly suspicious" characteristics of the Hispanic cohort compared to non-Hispanic with p-value of 0.05 (16.7% to 10.4%). In addition, there is a statistically significant higher prevalence of multifocal PTC in Hispanic patients compared to non-Hispanic, p-value of 0.002 (31.5% to 10.4%). However, no statistical difference in the ultrasound characteristics between the groups shown by a p-value of 0.244. Some subjects had surgical pathology lacking lymph node evaluation for adequate tumor-node-metastasis (TNM) staging, ideally the way of staging and classifying aggressiveness of PTC. The limitations, include this being a single center study, a sample size of 175, two factors that may not allow statistical differences to be detected in ultrasound characteristics and prognosis. A future evaluation of these groups including a larger sample size, several centers and standardized number of lymph nodes evaluated would improve the power of the results. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.