Objective To investigate the clinical value of ultrasonic positioning before sterilization in surgical treatment of thyroid disease. Methods A total of 80 patients with multiple thyroid lesions received ultrasonic positioning before sterilization for surgical treatment. We observed the number, location (in the upper and/or lower pole), and its distance to the posterior envelope. We also recorded the resection rate, the exploration time, and the incidences of complications(hoarseness and hypocalcaemia). Another 80 patients who did not receive ultrasonic positioning served as the controls. Results The lesions were rapidly identified in the ultrasonic positioning group, with the resection rate being 93.75% (75/80) and the exploration time being significantly shorter for patients with multiple lesions; moreover, ultrasonic positioning mades it unnecessary to expose the recurrent laryngeal nerve when the nodule was more than 5 mm away from the posterior envelope, so only 70.00% (56/80) of the patients exposed their recurrent laryngeal nerve. In control group, follow-up was the only available solution for the non-superficial nodules less than 5 mm, with the resection rate being only 76.25% (61/80); the only way to deal with dubious lesions was subtotal thyroidectomy, with the exposure rate of the recurrent laryngeal nerve being 92.50% (74/80). Significant differences were found between ultrasonic and non-ultrasonic groups in terms of resection rate and the exposure rate of the recurrent laryngeal nerve (P<0.01). One patient suffered from a slight deep voice after the operation due to the position of the cancerous node (close to the entrance to the throat of the recurrent laryngeal nerve), and no other patients suffered from severe postoperative complications. Conclusion Post-anesthesia ultrasonic positioning before sterilization can help to understand the numbers of thyroid lesions and their 3-dimensional distribution, and shorten the exploration time. So it is a technique that can not only improve the surgical accuracy and resection rate, but also reduce the difficulty of the surgery.