Objective?To study the clinical effect and application value of ultrasonography in differential diagnosis of nodular goiter and thyroid adenoma, in order to provide clinical reference. Methods?50 patients with thyroid disease admitted to People’s Hospital of Wanning from June 2019 to June 2021 were selected as the research subjects for retrospective analysis, and all patients received ultrasound examination. According to the pathological results of puncture, patients were divided into observation group (24 cases, nodular goitre) and control group (26 cases, thyroid adenoma). The characteristics of ultrasound images of patients in the two groups were compared, and the levels of hemodynamic parameters were recorded. Results?The number of patients with multiple lesions in the observation group was significantly higher than that in the control group, and the incidence of halo sign and capsule sign was significantly lower than that in the control group (P ＜ 0.05). There was no significant difference in lesion diameter, boundary and internal echo between the two groups (P ＞0.05). The blood flow signals of the observation group were mainly grade 0 and Ⅰ, while those of the control group were mainly grade Ⅱ and Ⅲ（P ＜0.05). The levels of peak systolic velocity (Vmax) and resistance index (RI) in and around the nodule in the observation group were significantly lower than those in the control group, the minimum end diastolic velocity (Vmin) in the blood flow around the nodule was significantly lower than that in the control group (P ＜0.05). There was no significant difference in the level of Vmin in nodules between the two groups (P ＞0.05). Conclusion?The ultrasonography can provide abundant quantitative and qualitative indexes, which is helpful to the differential diagnosis of nodular goiter and thyroid tumor.