Background: Thyroid nodules are a common problem in clinical practice, caused by congenital anomalies, inflammatory pathologies, and tumors. Thyroid nodules are a common endocrine problem, and while most are benign, differentiating between benign and malignant nodules is crucial for appropriate patient management. Ultrasonography (US) is the primary imaging modality for evaluating thyroid nodules and has high sensitivity of detecting benign nodules but its accuracy in definitively diagnosing malignancy can vary. Even though Final diagnosis relies on FNAC and histopathology of surgical specimens, every patient with thyroid nodules are not candidate for FNAC and histopathology diagnosis. This study aims to assess the accuracy of ultrasound characterisation of thyroid nodules compared with FNAC to reduce non-eligible patients from the invasive FNAC and histopathology procedure and avoid unnecessary surgery. Objective: The objective of this study is to assess the diagnostic accuracy of ultrasound in the characterisation of thyroid nodules compared to the fine needle aspiration results in patients visiting Tibebe Ghion hospital for thyroid scanning from December to January 2026 . Methods: This study was conducted at Tibebe Ghion specialised hospital in an institution-based cross-sectional study in patients visiting Tibebe Ghion specialized hospital scanned for thyroid disease and nodules detected with ultrasound and FNAC results. From December,1 to January 30,2026. The data was collected by trained radiology residents from December 1 to January 30, 2025. In this study, all patients who full fill the inclusion criteria in the study period were included .The questioners included questions on patient demography, duration of the symptoms, ultrasound and FNAC findings. Data were che cked for completeness and consistency and the data was collected by kobo software and then analyzed by SPSS compute software based on specific and general objectives. The two by two tables used to calculate the dependent variables. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value was calculated from the two by two table. Binary regression using bivariate and multivariate factors used to show the association of each independent variable with the dependent variable. The total cost of this study estimated was 30,000 ETB. RESULT. Among 131 nodules 26(19.8%) were malignant and 105 (80.2%) were benign by FNAC. ultrasound demonstrated a sensitivity of 80.8 % and specificity of 81%.the overall diagnostic accuracy was 80.9%.the positive predictive value was 51.2% while the negative predictive value was 94.4%.the positive likelihood ratio was 4.25 and the negative likely hood ratio is 0.24.a statistically significant association was observed between ultrasound diagnosis and FNAC results (x2=36.92,p=0.001) Conclusion, This study show ultrasound has high accuracy to detect and characterize benign thyroid nodules and can be used as a sensitive screening tool and avoid unnecessary surgical interventions but ultrasound has limitation to diagnosis malignant nodules accurately so that FNAC and histopathogic examination is mandatory to confirm ultrasound malignant looking lesions.