High-resolution ultrasound shows high sensitivity and excellent specificity to identify the nature of the thyroid nodules with advantages of being efficient, economical and noninvasive. Thus, it is the first-choice method for qualitative, quantitative, and locational diagnosis of thyroid nodules and the reference to the indications for fine needle aspiration. For effectively ascertaining the benign or malignant nature of the thyroid nodules and standardizing the application and management of thyroid nodule ultrasound, thyroid imaging reporting and data system (TIRADS) has emerged and developed over ten years to date. TIRADS not only changes the traditional understanding of thyroid nodules of the professional world as either being benign or malignant through the grading management, but also will become an important means of propelling the standardization, precision, and individualized diagnosis and treatment of thyroid diseases.