Background: Nodular thyroid disease is a common disorder and its incidence increases with age. They are three to four times more common in females than in males. The main risk of such nodules is the possibility of malignancy. In past decades, palpable thyroid nodules (TNs) were surgically excised to establish a tissue diagnosis, and in some instances completion thyroidectomy was needed if malignancy was detected which means more morbidity to the patients. On the same time the incidence of tissue diagnosed cancers in these nodules ranged from 12-20%; therefore it is logic to propose a more selective policy in choosing patients with thyroid nodules for whom surgery is required. Recently, advances in two diagnostic tools; namely ultrasonography (US) and fine-needle aspiration cytology (FNAC), and more recently the combination of both (Sonar Guided FNAC) served to revolutionize the treatment of TNs and to reduce the number of unnecessary surgeries for nodules that are predictably benign. Aim of the work: It was to evaluate the utility of the commonly used preoperative diagnostic tools in detecting malignancy in patients with TNs scheduled for surgery in our hospital by comparing its results to that of the gold standard investigation (postoperative histopathology). Patients and Methods: In General Surgery Department, Faculty of medicine, Zagazig University Hospitals, Zagazig, Egypt; one hundred patients with thyroid nodules were included in this study in the period from April 2012 to June 2016. They were 68 females and 32 males with mean age of 40.77±14.9. Complete clinical, laboratory and ultrasonographic examinations were carried out for all patients but sonar guided FNAC was done only for patients who accepted it. CT examination was ordered for patients with clinically suspicious malignant TNs. After making the preoperative diagnosis for each patient; the suitable thyroid surgery was carried out and the preoperative diagnosis was compared to the postoperative histopathologic one. Results were statistically analyzed using SPSS version 20 and showed: the largest number of patients with TNs (35%) presented in the fourth decade of life while the lowest one presented in the age group below 20 years (1%). Histopathologically, 39% of cases were found to have malignant TNs and the remaining 61% had non- malignant TNs and the most frequent malignant lesion was papillary carcinoma 79.5% followed by follicular carcinoma 10.3% and the most frequent benign lesion was colloid nodules 54.1% followed by follicular adenoma 23%. The sensitivity, specificity and accuracy rates of US were 92.3%, 44.3% and 63.0% and those of CT were 88.0%, 43.5% and 66.7%, while those of FNAC were 100.0%, 97.6% and 98.6% respectively. Conclusion: There is a quite high prevalence of malignant nodules in patients suffering from nodular thyroid disease. US has an integral role in preoperative evaluation of TNs as well as long-term post treatment follow-up. Sonar guided FNAC is a safe, easy, quick to perform, highly sensitive and accurate tool in diagnosing thyroid malignancy and plays a crucial role in the selection of patients with TNs for operation. It is readily repeatable, and has excellent patient compliance. So, all thyroid swellings should be thoroughly investigated for malignancy considering FNAC. Key wards: Nodular thyroid disease, Ultrasound, Fine Needle Aspiration Cytology and Thyroid malignancy.