Introduction: Ultrasound elastography is a newly developed non–invasive technique for evaluating thyroid nodules. This technique is very useful in differentiating malignant thyroid nodules from benign ones. Objective: To evaluate the diagnostic accuracy of ultrasound elastography in differentiating benign from malignant thyroid nodules by using FNAC as a references standard. Methodology: 150 patients were selected for study, every patient underwent in conventional and then ultrasound elastography examination along with colour Doppler imaging. As FNAC was reference standard all patient undergo FNAC for the same. Results: In our study, 43.3% (n=65 ) were males and 56.7% (n=85) were females, The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 72.7%, 96.4%, 61.5%, 97.8% and 94.7% respectively. Conclusion: Elastography has great potential as an adjunctive tool with other ultrasound modalities in diagnosing benign and malignant thyroid lesions.