BACKGROUND/AIMS: To assess the value of strain elastography (SE) in the distinction between benign and malignant thyroid nodules in patients with Hashimoto’s thyroiditis (HT). MATERIALS AND METHODS: The study cohort consisted of 74 thyroid nodules in 69 patients with HT. Fine needle aspiration biopsy (FNAB) or surgical excision were used as the reference standards. Gray-scale properties (internal structure, echogenity, presence or absence of hypoechoic halo sign, microcalcifications, “taller than wide” sign), vascularity scores, elasticity scores and strain ratios of all nodules were noted and compared between benign and malignant nodules. Categorical variables were compared using the Pearson chi-square test. Correlation analyses were performed using the Spearman correlation test. The diagnostic performance of the SE was evaluated using receiver operator characteristic (ROC) curves. RESULTS: Of the included 74 nodules, 67 (90.5%) and 7 nodules (9.5%) were benign and malignant, respectively. There were significant differences in echogenicity (p=0.017), peripheral halo (p=0.003), microcalcifications (p<0.001), and margin and shape (p=0.009) characteristics between benign and malignant nodules. There was a significant association between elasticity scores and histopathological diagnosis of the nodules (p<0.001). A cut-off point of 6.16 for SR value had sensitivity, specificity, PPV and NPV as 71.4%, 100%, 100% and 97.1%, respectively. Area under the ROC curve for the diagnostic performance of SR values in the differentiation of benign and malignant nodules was 0.797 (p=0.01) CONCLUSION: Our study revealed that SE is an accurate diagnostic tool to characterize thyroid nodules in patients with HT and this may be useful to avoiding unnecessary invasive procedures.