IntroductionStrain ultrasound-guided elastography (USE) could be used to differentiate malignant from benign thyroid lesions if its sensitivity and specificity are significantly high. Data on whether to rely on USE in differentiating thyroid nodules are unavailable, and fine-needle aspiration cytology (FNAC) remains the gold standard. However, FNAC carries a significant financial burden on hospitals and psychological stress on patients. Therefore, we conducted this study to determine the diagnostic accuracy of strain USE in thyroid lesions.