Uneven echogenicity of thyroid parenchyma is a description of thyroid ultrasound, indicating that the composition of the thyroid gland is not uniform, the main causes include thyroid nodules, Hashimoto’s disease, thyroid tumors, as well as trauma, etc., and need to be combined with other ultrasound indicators and thyroid tests and other tests to determine the condition. 1. Thyroid nodules: TI-RADS classification should be made based on other ultrasound findings such as nodule morphology, echogenicity, blood supply, calcification, etc., and different treatments should be taken according to the classification. 2. Hashimoto’s disease: it belongs to autoimmune disease, and the deposition of immune complexes may lead to inhomogeneity of the components in the thyroid gland and cause corresponding changes, which can be clearly diagnosed by checking the thyroid autoantibodies such as TRAb. 3. Thyroid tumor: mainly including thyroid adenoma and thyroid cancer, which may be manifested as thyroid swelling, causing uneven echogenicity, and can be diagnosed by pathological examination when necessary. 4. Trauma: trauma to the neck may cause damage to the thyroid gland, resulting in edema, hemorrhage, etc., leading to uneven echogenicity. The presence of uneven echogenicity of the thyroid parenchyma needs to be determined by combining clinical symptoms, other indicators of ultrasound and thyroid function tests, and then standardized treatment should be carried out under the guidance of the clinician after the diagnosis of the specific condition is confirmed.