AIM:To compare the diagnostic accuracy of preoperative Fine Needle Aspiration Cytology (FNAC) and ultrasound (USG) of thyroid swellings with post-operative Histopathological Examination (HPE) results. METHODOLOGY: A retrospective study of 60 consecutive patients was conducted from January 2013 to February 2014 in ENT department of our hospital. Ultrasound and Aspiration of thyroid swellings were taken after detailed clinical history, physical examination and thyroid function test. Ultrasound and FNAC reports were compared. 20 patients who underwent surgery, these patients FNAC were compared with final histopathological diagnosis. RESULTS:The sensitivity, specificity, PPV and accuracy of the FNAC when compared with HPE were 75%, 100%, 93% and 100% which was compared with other studies. CONCLUSION: Fine Needle Aspiration Cytology (FNAC) is considered gold standard cost effective diagnostic test for diagnosis of thyroid swellings than ultrasound. Based on the cytologic findings patients can be treated accordingly thus avoiding unnecessary surgery. HOW TO CITE THIS ARTICLE: