Thyroid nodules with an aspect ratio greater than 1 are not necessarily malignant and need to be combined with other ultrasound features and further pathologic examination to clarify their nature. Thyroid nodule aspect ratio greater than 1, can not be based on this feature to make a confirmation of the nature of the thyroid nodule. Other malignant ultrasound features, such as nodule density, nodule borders, and the presence of calcifications, should be combined to determine the risk of malignancy. The final judgment of the nature of the thyroid nodule needs to be based on pathological examination. If the aspect ratio of the thyroid nodule is greater than 1, and if the nodule is accompanied by unclear borders, sediment-like calcification, and abundant blood flow signals, the risk of malignancy needs to be more than 10%, and further thyroid puncture biopsy or intraoperative pathological biopsy can be performed. If the nodule is malignant, it needs to be surgically resected as soon as possible, and be supplemented with radiotherapy and chemotherapy according to the specific condition of the patient. There are also a small number of thyroid nodules with aspect ratio greater than 1, but they are benign and can be followed up regularly. If there is any abnormal change or if the nodule is large enough to cause localized pressure symptoms, it can be removed surgically. Please follow your doctor’s instructions for specific treatment.