Abnormal thyroid echogenicity is a symptom described by most thyroid patients during an ultrasound. Echo abnormalities in the thyroid gland generally include the following: First, for coarse echogenicity of the thyroid gland, most inflammatory diseases are considered, including hyperthyroidism, hypothyroidism, and the more common Hashimoto’s thyroiditis, all of which can have abnormal echogenicity. Secondly, some hypoechoic nodules are seen in nodular goiter and cystic nodules of the thyroid gland. The presence of strong echogenicity or hyperechogenicity in the thyroid gland usually refers to the vascular supply of the thyroid gland or calcification, especially strong echogenicity and sandy calcification of the thyroid gland, which are more obvious during ultrasound examination and indicate a higher possibility of thyroid cancer. Therefore, the presence of echogenic abnormalities in the thyroid gland must be taken seriously and a detailed consultation with a specific thyroid surgeon should be performed and different treatment plans should be adopted depending on the cause.