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Background  Thyroid nodules are highly prevalent, but a robust, feasible method for malignancy differentiation has not yet been well documented. This study aimed to establish a practical model for thyroid nodule discrimination.    Methods  Records for 2984 patients who underwent thyroidectomy were analyzed. Clinical, laboratory, and US variables were assessed retrospectively. Multivariate logistic regression analysis was performed and a mathematical model was established for malignancy prediction.    Results  The results showed that the malignant group was younger and had smaller nodules than the benign group (43.5 ± 11.6 vs. 48.5 ± 11.5 y,  p  < 0.001; 1.96 ± 1.16 vs. 2.75 ± 1.70 cm,  p  < 0.001, respectively). The serum thyrotropin (TSH) level (median = 1.63 mIU/L, IQR (0.89–2.66) vs. 1.19 (0.59–2.10),  p  < 0.001) was higher in the malignant group than in the benign group. Patients with malignancies tested positive for anti-thyroglobulin antibody (TGAb) and anti-thyroid peroxidase antibody (TPOAb) more frequently than those with benign nodules (TGAb, 30.3% vs. 15.0%,  p  < 0.001; TPOAb, 25.6% vs. 18.0%,  p  = 0.028). The prevalence of ultrasound (US) features (irregular shape, ill-defined margin, solid structure, hypoechogenicity, microcalcifications, macrocalcifications and central intranodular flow) was significantly higher in the malignant group. Multivariate logistic regression analysis confirmed that age (OR = 0.963, 95% CI = 0.934–0.993,  p  = 0.017), TGAb (OR = 4.435, 95% CI = 1.902–10.345,  p  = 0.001), hypoechogenicity (OR = 2.830, 95% CI = 1.113–7.195,  p  = 0.029), microcalcifications (OR = 4.624, 95% CI = 2.008–10.646,  p  < 0.001), and central intranodular flow (OR = 2.155, 95% CI = 1.011–4.594,  p  < 0.05) were independent predictors of thyroid malignancy. A predictive model including four variables (age, TGAb, hypoechogenicity and microcalcification) showed an optimal discriminatory accuracy (area under the curve, AUC) of 0.808 (95% CI = 0.761–0.855). The best cut-off value for prediction was 0.52, achieving sensitivity and specificity of 84.6% and 76.3%, respectively.    Conclusion  A predictive model of malignancy that combines clinical, laboratory and sonographic characteristics would aid clinicians in avoiding unnecessary procedures and making better clinical decisions.    Electronic supplementary material  The online version of this article (10.1186/s12902-018-0241-7) contains supplementary material, which is available to authorized users.

A predictive model of thyroid malignancy using clinical, biochemical and sonographic parameters for patients in a multi-center setting