Abstract: Objective To investigate the diagnostic value of high-frequency color Doppler ultrasound （CDU） in cervical lymph node metastasis of thyroid carcinoma （TC）. Methods Eighty-five patients with TC in The Third People's Hospital of Hainan Province from 2015 to 2019 were enrolled in the study. Color Doppler ultrasonography was used to examine the imaging features and estimate the diagnostic value of CDU in cervical lymph node metastasis of thyroid cancer. Results There were 79 papillary carcinomas, 1 squamous cell carcinomas, 3 follicular carcinomas and 2 medullary carcinomas among the 85 TC patients. Pathologically confirmed TC external lymph node masses were 215, of which 121 were metastatic TC and 94 were reactive hyperplasia lymph node. The diagnostic sensitivity of high-frequency CDU was 73.5%, the specificity was 80.0%, the positive predictive value was 85.6%, and the negative predictive value was 71.2%. The CDU images of metastatic lymph nodes showed that the cystic changes （15.7%）, punctate hyperecho （34.7%）, peripheral blood flow （40.5%）, and the high echo of the portal （80.2%） were significantly higher than the reactive hyperplasia lymph nodes （0.0%, 0.0%, 0.0%, 11.7%, respectively, all P<0.05）. The blood flow abundance of metastatic lymph nodes was significantly higher than that of the reactive hyperplasia lymph nodes （P<0.05）. The peak systolic velocity （PSV） （35.72±6.63 cm/s） and resistance index （RI） （0.77±0.08） of metastatic lymph nodes were significantly higher than the reactive hyperplasia lymph nodes （24.15±8.27 cm/s, 0.61±0.09, P<0.05）, but the pulsatility index （PI） values were not significant difference （P>0.05）. Lymph nodes metastasis were mainly in area Ⅵ, followed by area Ⅲ and Ⅳ. Conclusions High-frequency CDU can distinguish the characteristics of TC cervical lymph node metastasis and may have high diagnostic value.