Objective: The objective was to assess the utility of gray–scale USG to identify patterns of thyroid nodules and to correlate the characteristics of benign and malignant nodules with pathological diagnosis. Materials and Methods: From March2018 to August 2018, a total of 100 patients (15 males and 85 females), with 150 nodules detected at USG, were included in this study. The characteristics of each nodule were determined. The results were then compared with fine needle aspiration (FNA)/histopathological diagnosis. Results: Of the 150 nodules examined, 25 (16.66%) were found to be malignant on cytopathology. The malignant nodules demonstrated solid or predominantly solid composition; presence of microcalcification; irregular or poorly defined margins; anteroposterior (AP) diameter > transverse diameter; absent or thick incomplete halo and markedly hypoechoic character. Among males, malignant nodules were found in 36.8%, whereas in females the occurrence was 16.7%. Conclusion: Gray–scale USG features of thyroid nodules are useful to distinguish patients with clinically significant thyroid nodules from those with innocuous nodules despite the overlap of findings. From our study, it is apparent that the USG findings of poorly defined margins, marked hypoechogenicity, microcalcifications, and a taller–than–wider shape have a high diagnostic accuracy for identifying malignant thyroid nodules.