目的 通过对术前TSH水平与超声异常征象分析，了解两者在甲状腺微小结节诊断中的临床价值。方法 回顾分析经细针穿刺或手术病理证实的258例共361枚甲状腺微小结节（长径≤1.0cm）的术前TSH水平与超声异常征象资料。结果 随着TSH水平升高，甲状腺微小结节的恶变率也随之上升；超声异常征象中，微钙化阳性预测值最高，其次为边界不清；TSH＞4.95mIU/L、超声微钙化、边界不清三者的特异性相似；TSH浓度水平与超声异常征象的灵敏度均较低，若TSH>4.95mIU/L且超声异常征象发现微钙化或边界不清时将明显提高灵敏度。TSH分组统计中①组与②组、③组、⑤组、⑥组差异有统计学意义；①组与④组，②组与③组，⑤组与⑥组差异无统计学意义。结论 术前TSH浓度水平大于4.95mIU/L是甲状腺微小结节恶变危险因素，若TSH>4.95mIU/L且超声异常征象发现微钙化或边界不清时将明显提高甲状腺微小结节诊断的准确性。

Objective To explore the value of TSH level and abnormal ultrasound features in the diagnosis of thyroid micro-nodules. Methods The concentration of TSH and the abnormal ultrasound features in 258 patients with 361 thyroid micro-nodules (the maximum diameter ≤ 1cm) which confirmed by fine needle aspiration or post-surgical histopathology were retrospectively analyzed. Results The malignant transformation rate of thyroid micro-nodules increased with the increase of TSH level. The micro calcification in abnormal ultrasound features had the highest positive predictive value, the second was ill-defined border. The TSH level (>4.95mIU/L), micro calcification and ill-defined border had similar specificity in the diagnosis of thyroid micro-nodules, but the sensitivity of TSH level and abnormal ultrasound features were lower. The combined detection TSH (>4.95mIU/L) level and abnormal ultrasound features (micro calcification or ill-defined border) could significantly improve the diagnostic sensitivity. Conclusion The preoperative TSH (>4.95mIU/L) could be used as an indicator in the diagnosis of malignant thyroid micro-nodules. The combined detection of TSH (>4.95mIU/L) level and abnormal ultrasound features (micro calcification or ill-defined border) might significantly improve the diagnostic accuracy.