Objective: This study aims to investigate the consistency of serological markers and ultrasound image of Hashimoto’s thyroiditis with the gold standard histopathologic diagnosis. Methods: Seven hundred and thirty patients were consecutively included in this retrospective analysis. These patients were admitted to hospital as the diagnosis of thyroid nodule for thyroidectomy and histopathologic identification, whose TPOAb, TgAb and thyroid ultrasound were performed before surgery. Results: Of 730 patients, the elevated level of TPOAb or TgAb was detected among 187 patients (25.62%), diffuse heterogeneity on thyroid ultrasound was exhibited among 249 patients (34.11%), and chronic lymphocytic thyroiditis was identified by histopathology following thyroidectomy among 215patients (29.45%). Of these 215 patients with histopathologic evidence, only 156 patients(72.56%) had elevated TPOAb or TgAb with sensitivity of 72.56% and specificity of 93.98%, 163 patients (75.81%) had diffuse heterogeneity on ultrasound image with sensitivity of 75.81% and specificity of 83.30%, and serological indicators combined with ultrasonic findings with sensitivity of 86.98% and specificity of 79.81%. One hundred and thirty-two patients (61.40%) had both elevated TPOAb or TgAb and diffuse heterogeneous image. Consistency analysis of elevated serological markers, diffuse heterogeneous ultrasound image and these two examinations combined with histopathology revealed kappa 0.6916 (P<0.001) and 0.567(P<0.001) 0.605 (P<0.001), respectively, which demonstrated that TPOAb or TgAb had higher agreement than ultrasound did with histopathology. Conclusion: Both elevated TPOAb or TgAb and diffuse heterogeneity on thyroid ultrasound had moderate agreement with histopathology, with serological markers and ultrasound evidence combined of higher sensitivity and serological markers of higher specificity.