BACKGROUND Neck swelling is a common presentation in the course of number of diseases. This condition is generally not a disease by itself, rather it may be a symptom of many possible underlying problems. MATERIALS AND METHODS The study includes 100 patients with neck swelling attending the Surgical Outpatient Department of Government Hospital, Guntur. Patient's data was recorded. Samples of FNAC were taken from the swelling and sent for cytology. Ultrasonography was performed for the neck swelling and results were interpreted in correlation with cytology. RESULTS Thyroid lesions accounted for the majority (57%) followed by lymph node enlargement (27%). Benign lesions were most common, of which thyroid goitres more common in female sex were found. The most common lymph nodal lesion is tuberculous/granulomatous lymphadenitis. In toto malignant lesions accounted for 23% of cases and their incidence rose sharply after 4th decade. The most common benign lesion was nodular goitre, inflammatory lesion was thyroiditis, most common malignant lesion was metastatic secondaries of neck and papillary carcinoma thyroid which was more common in young females. CONCLUSION The most common single pathological diagnosis in our study was found to be goitrous lesion of thyroid, most likely attributed to the endemicity of fluorosis in the catchment area of the hospital. High index of suspicion of malignancy needs to be borne in mind in dealing with a lymph node swelling in elderly.