Objective[|]We aimed to establish whether employing the strain index method by applying manual compression synchronized with the diastolic period of the carotid artery by sonoelastography was useful to manage thyroid nodules.[¤]Materials and Methods[|]Some 289 nodules belonging to 260 consecutive patients with thyroid nodules were prospectively included in this study. Both B-mode sonography and sonoelastography images were taken for each lesion. The strain indices (ratio of normal thyroid parenchyma to nodule strain) for the nodules were computed by making use of the same level and normal-appearing thyroid region as an internal reference. A comparison was made between the findings and histopathology or fine-needle aspiration biopsy. The diagnostic performances of both the strain index method and B-mode sonography were determined. Youden’s index was utilized to compare the two methods[¤]Results[|]The mean strain index values were 1.52±2.43 (in the range 0.49-29.70) for 268 benign nodules and 4.94±3.96 (in the range 1.28-47.60) for 21 malignant nodules. Sensitivity and specificity were 88% and 80%, respectively, for B-mode sonography, whereas they were 75% and 93%, respectively, for the strain index method when the cutoff point used was 3.40. Youden’s index was 0.68 for both B-mode sonography and the strain index method.[¤]Conclusion[|]The strain index method using the external manual compression method synchronized with the diastolic period of the carotid artery by sonoelastography may be a diagnostic method that increases specificity in the management of thyroid nodules. Nevertheless, its diagnostic performance appears not superior to B-mode sonography.[¤]