Clinically, solitary thyroid nodules are common. The majority are benign and thyroid cancer represents as an uncommon clinical problem. Fine needle aspiration cytology (FNAC) provides a valuable idea about the nature of thyroid tumours. It excludes most of the malignancies before any other investigations.An attempt was made to determine the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of solitary thyroid nodule and to avoid unnecessary surgery. This is a prospective analytical study conducted in the Department of Surgery and Department of ENT, V.S.S Medical College and Hospital, Burla, Sambalpur from November 2011 to October 2012 (one year) taking 210 OPD patients and 33 indoor patients. Out of 33 cases, FNAC showed 26 cases as benign and 7 cases as malignant lesions, while histopathological examination revealed 25 benign and 8 malignant lesions. FNAC was able to correctly pick 23 benign lesions, while 3 cases of benign lesions turned out to be malignant on histopathology (False negative). Out of total 8 cases which turned out to be malignant on histopathology, FNAC was able to pick 5 cases, while 2 benign lesions was misdiagnosed as malignant (false positive). The analysis of study showed a sensitivity of 62.5% and specificity 92% (p value= 0.001) of FNAC in detecting malignancy in solitary thyroid nodule. This study reveals that FNAC is highly effective in detecting thyroid malignancy in solitary thyroid nodule with a high specificity (92%) and a relatively low sensitivity (62.5%) in our study.