Abstract: Objective To explore the application of virtual touch tissue imaging (VTI) combined with ultrasound vascular enhancement technique (VET) in the diagnosis of focal hypoechoic Hashimoto thyroiditis (FHT). Methods A total of 52 hypoechoic thyroid lesions, including 20 FHT cases and 32 papillary thyroid carcinoma (PTC) cases, which were diagnosed by ultrasound-guided fine needle aspiration (FNA) or surgical pathology were selected and their clinical data were retrospectively analyzed. The characteristics of the lesions were observed by high-frequency ultrasound, VTI and VET to evaluate the diagnostic efficacy of VTI combined with VET for hypoechoic FHT. Results The VTI score was 1 to 3 for 95% (19/20) FHT cases and 4 to 5 for 78% (25/32) PTC cases, which was statistically different (P<0.05). VET results showed that there were statistical differences between FHT and PTC in the vascular morphology and the echo of thyroid tissue within and outside the lesion (P<0.05). When VTI score ≤3 combined with VET were used for diagnosis efficacy of the echo of thyroid tissue within and outside the lesion for FHT, the sensitivity, specificity, and accuracy was 85.0%, 93.8%, and 90.4%, respectively. Conclusions VTI combined with VET can effectively distinguish hypoechoic FHT and PTC and improve the diagnostic accuracy of hypoechoic FHT, with high clinical application value.