Objective：To compare the diagnostic efficacy of sonographic pattern from American Thyroid Association（ATA）Management Guidelines，thyroid imaging reporting and data system from Korean Society of Thyroid Radiology（K-TIRADS）and American College of Radiology（ACR-TIRADS）in diagnosis of thyroid nodules. Methods：From January 2012 to October 2017，756 patients with 1 065 thyroid nodules underwent preoperatively thyroid ultrasonographic examination and operation in Jiangsu Province Hospital on Integration of Chinese and Western Hospital. The general information of patients and ultrasound features of their thyroid nodules were collected. All nodules were categorized based on ATA sonographic pattern，K-TTIRADS and ACR-TIRADS. The receiver operating characteristic curve（ROC）curve was constructed，and the best diagnostic cut-off was selected according to the Youden index to compare their diagnostic performance. Results：Among 1 065 thyroid nodules，388 cases（36.43%）and 677 cases（63.57%）were confirmed to be benign and malignant by postoperative pathology，respectively. Ultrasound features including hypoechogenicity，solidity，microcalcification，irregular margin and aspect ratio＞1 had a higher rate of malignancy. The malignancy rates of each ATA sonographic pattern from low to high suspicious were 2.99%，23.53%，69.23% and 93.37%，respectively（P < 0.001）. The malignancy rates of category 3，4 and 5 nodules made by K-TIRADS were 13.33%，48.64% and 95.91%，respectively（P < 0.001）. The malignant rates of category 2，3，4 and 5 nodules made by ACR-TIRADS were 3.36%，13.22%，56.09% and 91.16%，respectively（P < 0.001）. Surprisingly，18.4% of thyroid nodules could not be categorized into any ATA pattern，of which 44.9% were ultimately found to be malignant. The ACR-TIRADS had a higher sensitivity and negative predictive value compared to K-TIRADS and ATA sonographic pattern. Conclusion：Three ultrasound reporting systems have certain clinical application value for diagnosis of thyroid nodules. Due to a small proportion of thyroid nodules can’t be classified by ATA sonographic pattern，TIRADS is worthy of further clinical research and application.