Ultrasonography of thyroid nodules suggesting punctate strong echoes may represent papillary carcinoma appearing as grit bodies, which may also be dystrophic calcifications or condensed colloid, etc. There is a portion of punctate echoes smaller than 1 mm with no posterior acoustic shadow and no comet tail artifacts, making it difficult to determine whether they are microcalcifications or condensed colloid or other components; such punctate echoes are called punctate echoes of uncertain significance. Patients with nodular echoes found on ultrasound need to further improve the thyroid function test and other related auxiliary tests to finally determine the cause of the disease, and it is recommended that the patient go to the endocrinology department of a regular hospital for detailed counseling and follow the doctor’s instructions for diagnosis and treatment.