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Objective To investigate the combination of ultrasound imaging features and serum thyroid stimulating hormone (TSH), thyroglobulin (TG), thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb) in evaluating the risk of invasive papillary thyroid carcinoma (PTC). Methods A total of 587 patients with PTC confirmed by surgery and pathology in Affiliated Tongzhou Hospital of Nantong University from January 2022 to December 2022 were analyzed and were divided into metastasis group (n=235) and control group (n=352) according to postoperative pathological results. The age, gender, location, size, structure, echo, shape, margin, calcification, relationship with thyroid capsule, ultrasound characteristics of blood supply of PTC and serum level of TSH, TG, TGAb and TPOAb were compared between the two groups, and the correlation between these characteristics and cervical lymph node metastasis was analyzed. Results The nodules of the two groups of PTC patients were all solid, and there was no statistically significant difference in position, structure, internal echo, and aspect ratio of morphology (P＞0.05). There were statistically significant differences in the maximum diameter, margin, calcification, relationship with thyroid capsule, and blood supply of nodules between two groups (P＜0.05). Logistic regression analysis showed that maximum diameter, margin, blood supply, relationship between nodules and thyroid capsule, and serum level of TSH, TG, TGAb, TPOAb were independent influencing factors for PTC metastasis （P＜0.05）. Conclusion Ultrasound imaging combined with serum TSH, TG, TGAb, and TPOAb has important clinical significance for preoperative assessment of PTC invasion.