Background: Thyroid nodules are a common problem which requires an accurate cytological diagnosis for proper management. An essential investigation modality is fine needle aspiration cytology (FNAC) with a sensitivity ranging between 80-90%. Recommendations vary regarding the use of ultrasound in improving the accuracy of free hand fine needle aspiration biopsy. Objective: The aim of our study was to investigate the role and accuracy of ultrasound guided fine needle aspiration cytology in the evaluation of patients with thyroid nodules. Methods: Forty four patients with nodular thyroid disease who were assessed by ultrasound guided fine needle aspiration cytology (US-FNAC) followed by thyroidectomy were identified. Retrospective analysis of data on the cytology specimens and histological results was carried out. Results: The sensitivity and specificity of US-FNAC for diagnosing thyroid neoplasms were 91.7% and 93.3% respectively. The diagnostic accuracy was 92.8%, with the rate of inadequate smears as 4.6%. Conclusions: Ultrasound guided fine needle cytology of thyroid nodules yields more accurate results, with a decrease in the number of inadequate sample category. Precise targeting of lesions in both palpable and non palpable thyroid nodules by the FNA needle under ultrasound guidance will increase the diagnostic accuracy, thereby avoiding or reducing the number of unnecessary thyroid surgeries.