Background: Neck swelling is common clinical presentation in E.N.T practice. Enlargement of thyroid remains a problem of enormous magnitude all over the world. It becomes a challenge to come out with proper diagnosis and management. This study is undertaken to study the cytology of palpable thyroid lesions to minimize surgical intervention and correlating the same with the thyroid function test and histopathological examination to confirm the diagnosis and planning post-surgical management of malignant thyroid lesions. Methods: This is interventional prospective study, done at ENT department of civil hospital, Rajkot. The aim of our study is to find correlation between fine needle aspiration cytology and histopathology of thyroid swellings, to access accuracy of fine needle aspiration cytology in evaluation of thyroid swelling and to perform clinical assessment of different types of thyroid swellings with sample size of 100 patients. Those patients presenting with thyroid swellings who underwent Fine Needle Aspiration Cytology, thyroid surgery and histopathological examination are included and thyroid swelling patients which were not operated are excluded. Results: Various factors regarding clinical examination, investigation, histopathological characteristics, operative treatment and follow up of the patients have been analysed. The maximum incidence of thyroid lesions, are between the ages of 31 – 40 years. More malignant cases are seen during third decade of life. The colloid goitre is the most common pathology found. Some cases of papillary carcinoma thyroid without palpable neck nodes. Hemithyroidectomy is the most commonly (73%) done surgery. In present study, accuracy of FNAC is 93%. Conclusions: Sensitivity and specificity of FNAC in detecting thyroid pathology is 85% and 100% respectively. In present study, out of 92 (92%) cytological diagnosed cases, 88 (95.65%) cases were confirmed benign on histological diagnosis and (4.35%) was malignant on histological diagnosis. These findings are comparable with results carried out by the other studies reported earlier. FNAC is gold standard in the selection of the patients for surgery. FNAC too requires expertization. The main limitation of thyroid FNAC is the inability to distinguish between follicular adenoma and carcinoma.