Mixed echogenic thyroid nodules with clear borders are the results of thyroid ultrasound report, which may be benign or malignant. Whether treatment is needed has to be combined with other features of the nodule and the patient’s clinical manifestations to make a comprehensive judgment, and if it is benign, it does not need special treatment, while malignant usually requires surgical resection. Commonly used malignant ultrasound features of thyroid nodules are solidity, microcalcification, very low echogenicity, irregular margins, and perpendicularity; while comet tail pseudo-image is an ultrasound feature of benign nodules. Therefore, the judgment of benign and malignant nodules should be based on the nature of the nodule as well as the orientation of the nodule. In addition, the size of the nodule is also an important factor. The grading of the nodule according to TIRADS can be used as a reference standard for predicting the benign or malignant status, and fine-needle aspiration can also be used to determine the benign or malignant status of the nodule. If the nodule is determined to be benign, no special treatment is needed, and regular follow-up is sufficient to observe whether the nodule develops further, and if symptoms such as pressure appear, surgical resection may be chosen; if it is malignant, early surgical resection is recommended. It is recommended that when a mixed echogenic nodule with clear borders appears in the thyroid gland, consult a doctor in a timely manner to determine whether treatment is needed under the guidance of the doctor.