Introduction: Fine needle aspiration cytology is considered as a reliable investigation for evaluation of thyroid swelling to differentiate between benign and malignant lesion. Ultrasonography findings, such as echogenicity, size, composition, microcalcifications and vascularity pattern, have been found to be associated with malignancy. Objective: The aim of this study was to evaluate the validity and reliability of Fine needle aspiration cytology and ultrasonography in patients with thyroid swelling. Results: In present study, out of the 125 patients, Cytology diagnosed neoplasm in 14 (11.2%) patients. After excluding these patients the sensitivity of cytology in detecting malignancy in the remaining 114 (88.8%) patients was 25%, specificity was 98.83%. and p– value was 0.0001, which was statistically significant. The sensitivity of ultrasonography was statistically significant for size, vascularity and microcalcification while not significant for echogenicity and composition. Conclusion:  It was concluded a combination of various diagnostic modalities, rather than any single modality, will give optimal results and final diagnosis can be made on histopathological examination only.