Objective: To study the difference in ultrasonic strain ratio between benign and malignant thyroid nodules and its correlation with cell apoptosis and invasion. Methods: A total of 130 patients diagnosed with thyroid nodules by ultrasonography in our hospital between April 2014 and April 2016 were selected, and the pathological results were referred to distinguish between benign and malignant nodules. Thyroid ultrasonic elastography was performed to determine strain ratio (S/R), and thyroid biopsy tissue or surgically removed tissue was collected to determine the content of apoptosis and invasion-related molecules. Results: S/R of malignant thyroid nodules was significantly higher than that of benign nodules; Wip1, Livin, MMP1, MMP9, TCF and β-catenin content in malignant thyroid nodules were significantly higher than those in benign nodules while CCNG2, PPZA2, Caspase9, Kiss-1 and GPR54 content were significantly lower than those in benign nodules; Wip1, Livin, MMP1, MMP9, TCF and β-catenin content in malignant thyroid nodules with high S/R were significantly higher than those in nodules with low S/R while CCNG2, PPZA2, Caspase9, Kiss-1 and GPR54 content were significantly lower than those in nodules with low S/R. Conclusions: Ultrasound S/R of malignant thyroid nodules is significantly higher than that of benign nodules and the higher the S/R, the more exuberant the cell proliferation and invasion in malignant nodule tissue.