Objective: To determine the efficacy of fine needle aspiration and cytology (FNAC) in the solitary thyroid nodules at tertiary care Hospital. Materials and Methods: This study was conducted in department of general surgery at Liaquat University Hospital Jamshoro/ Hyderabad during one year from June 2015 May 2016. The study included all subjects of any gender and age who had a solitary nodule that was confirmed clinically or through thyroid scan. To achieve a tissue diagnosis before surgery, the study participants experienced fine needle aspiration cytology (FNAC). The resected specimens were submitted for histopathology investigation postoperatively. Diagnostic accuracy of FNAC was assessed by cross tabulation by taking histopathology as gold standard. The data was gathered by using a self-made proforma and analyzed with SPSS version 20. Results: Total fifty solitary thyroid nodules (STN) patients were studied. Mean age of the patients was 34.54+10.3 years. Of 50 patients, 46(92%) & 4(8%) were females and males respectively with male & female ratio of 1:11.5. 28(56%) STN were on right lobe, left side in 19(38%) cases; on isthmus in 3 (6%) cases. As per FNAC results, nodular colloid goiters were seen in 66% cases, follicular neoplasm in 10%, papillary carcinoma in 10%, Hurthle cell variation in 6%, benign cystic lesion in 4% of cases, neoplastic cystic lesion in only 1 case, and also only 1 study subject was suspected for malignancy. Thyroid function tests were normal in all patients. FNAC showed a significant efficacy with 83.3% sensitivity, 86.8% specificity, 86% diagnostic accuracy, 66.6% PPV and 94.28% NPV when histopathology was taken as a gold standard. Conclusion: In the conclusion of this study the FNAC observed to be a simple, safe and effective diagnostic tool in detecting the thyroid malignancies as solitary thyroid nodules with 83.3% and 86.8% sensitivity and specificity respectively.