Objective: To investigate the value of high frequency ultrasound combined with real-time tissue elasticimaging (RTE) in diagnosis of pillary thyroid microcarcinoma (PTMC). Methods: The diagnostic efficiency of high frequency ultrasound, RTE, high frequency ultrasound combined RTE for PTMC were compared. Results: The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of high frequency ultrasound combined RTE were respectively 91.07%, 91.55%, 91.34%, 92.86% and 89.47%, which were all obviously higher than high frequency ultrasound (73.21%, 80.28%, 77.16%, 79.17%, 74.54%) and RTE (78.57%, 81.69%, 80.31%, 82.86%, 77.19%) (P˂0.05). Conclusions: High frequency ultrasound combined RTE can significantly improve the diagnostic efficiency of PTMC.