Thyroid nodules are common medical problem caused by a variety of thyroid disorders. The aims of this study was to evaluate the sonographic-pathologic concordance and discordance of thyroid nodules and to demonstrate how ultrasound is integrated with the fine needle aspiration to provide valuable information that can be used to improve patient care. This prospective study was done on 76 patients with thyroid nodules referred for ultrasound examination. From 76 patients involved in this study and underwent ultrasound-guided fine needle aspiration cytology, 10 patients have inadequate aspirates and thus were excluded. Of the remaining 66 patients that were included in our study, only 6 patients had thyroid carcinoma (9%). Thyroid cancer was highest in age group of 50-59 years (50%). Five patients of thyroid carcinoma (83.3%) had solitary nodule more than 10 mm in largest dimension and only one patient (16.7%) had multiple thyroid nodules. After sonographic-pathologic correlation, the concordance and discordance rate presented as: (1) concordant benign (98.11%), (2) concordant malignant (71.42%), (3) discordant benign (14.28%), (4) discordant malignant (1.88%) and (5) borderline or high risk (30.76%). We conclude that careful sonographic-pathologic correlation and appropriated post-biopsy management will allow detection of a substantial number of false negative results immediately after needle biopsy by identifying discordant lesions prospectively, thereby avoiding delays in the diagnosis of cancer.