Objective: To observe the combined diagnostic efficacy of real-time shear wave elastography (SWE) technology and two-dimensional ultrasound technology in thyroid cancer under the background of Hashimoto"s thyroiditis. Methods: Eighty patients with thyroid nodules and Hashimoto"s thyroiditis admitted to our hospital from January 2022 to December 2023 were selected and underwent two-dimensional ultrasound and SWE examination. The combined diagnostic value of two-dimensional ultrasound and SWE was analyzed. Results:The pathological results showed that a total of 80 nodules were detected in 80 patients, including 52 benign and 28 malignant; Two dimensional ultrasound efficacy: sensitivity 71.43%, specificity 96.15%, positive predictive value 90.91%, negative predictive value 86.21%, accuracy 87.50%; SWE efficacy: sensitivity 78.57%, specificity 94.23%, positive predictive value 88.00%, negative predictive value 89.09%, accuracy 88.75%; Joint efficacy: sensitivity 92.86%, specificity 98.08%, positive predictive value 96.30%, negative predictive value 96.23%, accuracy 96.25%; The sensitivity and accuracy of joint diagnosis are both greater than SWE and two-dimensional ultrasound (P<0.05); The AUC of two-dimensional ultrasound combined with SWE technology is the highest. Conclusion: The combination of two-dimensional ultrasound and SWE has a high diagnostic efficacy in patients with Hashimoto"s thyroiditis and thyroid cancer. Two dimensional ultrasound and SWE techniques can be performed simultaneously to improve the detection of thyroid cancer.