Objective：To compare the clinical characteristics of patients with Hürthle cell adenoma（HCA） and multinodular goiter （MNG），and to summarize the clues for the diagnosis of HCA. Methods：A total of 92 patients，who underwent resection of thyroid nodules in Peking University First Hospital from January 2000 to December 2017 and were confirmed to have HCA according to postoperative histopathological analysis of paraffin-embedded sections，were enrolled. Meanwhile，276 age-，sex-，and year-of-opera－tion-matched patients with MNG were enrolled and paired with the above patients with HCA at a ratio of 3∶1. The two groups of patients were compared for the differences in course of disease，clinical manifestations，thyroid function，thyroid peroxydase antibody （TPOAb），thyroglobulin antibody（TgAb），thyroglobulin（Tg），and ultrasonographic characteristics. Results：There were no significant differences between the two groups in patients’ family history，course of disease，clinical manifestations，preoperative thyroid function，and positive rates of TPOAb，TgAb，and Tg. The maximum diameter of thyroid nodules in the HCA group was significantly larger than that in the MNG group（P<0.05），and the rate of nodules with a diameter of not less than 2 cm was significantly higher in the HCA group than in the MNG group（P<0.05）. The HCA group had a significantly higher proportion of patients with solitary and solid nodules and abundant intra-nodular blood flow on ultrasonography than the MNG group（P <0.05）. Conclusion：It is difficult to distinguish HCA from MNG just from the course of disease，symptoms，thyroid function，and presence or absence of antibodies. It may indicate the possibility of HCA if relatively large，solitary，and solid nodules with abundant intra-nodular blood flow are found on ultrasonography.