Key PointsQuestionHow can the integration of artificial intelligence (AI) decision aids be optimized to enhance efficiency in thyroid nodule management?FindingsIn this diagnostic study involving 16 radiologists and 2054 ultrasonographic images, junior radiologists were instructed to use the traditional all-AI strategy, while senior radiologists were advised to apply the optimized integration of AI. The optimized approach was associated with reduced diagnostic time and maintained high diagnostic performance.MeaningThis study suggests that radiologists with different expertise levels can fully integrate AI-generated suggestions based on the optimized integration of AI decision aids, which provides the theoretical basis for human-machine integration for thyroid nodule management.