BACKGROUND: Contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) have been widely used in the diagnosis of thyroid nodules. The main purpose of this study was to investigate the diagnostic value of CEUS combined with SWE for Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) category 4 thyroid nodules. METHODS: CEUS and SWE were performed on 219 patients with 219 C-TIRADS category 4 thyroid nodules. Receiver operator characteristic (ROC) curves were drawn based on the surgical and pathological results. The diagnostic efficacy of CEUS, SWE, and CEUS and SWE combined were analyzed and compared. RESULTS: The areas under the curve (AUCs) of the ROC curves for CEUS and SWE were 0.899 [95% confidence interval (CI): 0.847-0.951] and 0.838 (95% CI: 0.775-0.901), respectively. The diagnostic sensitivity, specificity, accuracy, negative predictive value (NPV), positive predictive value (PPV), positive likelihood ratio (LR CONCLUSIONS: For C-TIRADS category 4 thyroid nodules, CEUS and SWE had high diagnostic efficacy, and the combination of CEUS and SWE further increased the diagnostic sensitivity, NPV, and accuracy, and thus could be used to help guide the treatment and management of patients.