Objectives: The aim was to study the patterns of solitary thyroid nodule with real-time contrast-enhanced ultrasound (CEUS) and assess its value in differentiating between malignant and benign thyroid nodules. Materials and Methods: Seventy-eight patients with solitary thyroid nodule (37 malignant, 41 benign) underwent real-time CEUS. The patterns of their enhancement were assessed from six aspects: Degree of enhancement, process of enhancement, homogeneity of enhancement, completeness of enhancement, boundary of the enhanced lesions, and shape of the enhanced lesions. Results: Contrast-enhanced patterns were significantly different between benign and malignant thyroid nodules (P < 0.05), except for process of enhancement. The shape of most malignant lesions was irregular (94.59%), the boundary was unclear (86.49%) and had no significantly enhanced (78.38%). Most malignant lesions became inhomogeneously (78.38%) and incompletely enhanced (70.27%). Conclusions: The patterns of real-time CEUS are significantly different between benign and malignant thyroid nodules, and have important clinical value.