Background: The assessment of solitary thyroid nodules (STNs) requires a combination of clinical evaluation and advanced diagnostic modalities to determine malignancy risk and guide management. This study evaluates the diagnostic accuracy of ultrasound (USG), fine needle aspiration cytology (FNAC), and other imaging techniques in the assessment of STNs. Methods: A total of 51 patients with STNs were analyzed based on demographic characteristics, thyroid function tests, TI-RADS classification, FNAC results, and final histopathological diagnoses. The sensitivity and specificity of USG and FNAC were assessed for their diagnostic utility. Results: The majority of patients (52.9%) were aged 20–40 years, with a higher female prevalence (64.7%). Among nodules, 35.3% were classified as TR4 (moderately suspicious) and 15.7% as TR5 (highly suspicious) based on TI-RADS. FNAC categorized 58.8% of cases as benign, 23.5% as suspicious, and 17.6% as malignant, whereas histopathology confirmed 68.6% benign and 31.4% malignant cases. The sensitivity and specificity of USG were 88.5% and 79.3%, respectively, while FNAC demonstrated higher accuracy with 94.1% sensitivity and 86.7% specificity. Conclusion: FNAC remains the gold standard for STN evaluation, offering superior sensitivity and specificity. However, USG, particularly with TI-RADS classification, serves as an essential non-invasive tool for initial risk stratification. Limited use of advanced imaging modalities suggests the need for optimized diagnostic pathways. A combined approach improves diagnostic accuracy and informs appropriate management strategies.