Aim: To find the correlation of preoperative ultrasonography (USG) and post operative histopathology report in thyroid disease. Objective: To correlate pre-operative USG and post operative histopathology report in benign and malignant thyroid diseases. To study the incidence of benign versus malignant lesion of thyroid disease in our setting. To determine the sex predilection among benign versus malignant thyroid disease in our setting. Methods: It was a prospective, descriptive, cross sectional study. Patients presenting with thyroid swellings and undergoing thyroid surgery were included in this study. Patients underwent USG neck using GE VOLUSON E8 scan machine and Linear probe 9L Frequency and were reported regarding the shape, size, echogenicity, calcifications, margins, vascularity, and lymphnode status. After the surgery thyroid specimen was sent for HPE analysis to confirm the final diagnosis. Histopathology report were collected and correlated with pre op USG findings. Results: 45 patients were included in this study out of which 11 patients turned out to be malignant and 34 benign. Out of 45 patients 37 were female and 8 were male. USG features. Conclusion: Malignant thyroid nodules demonstrated ultrasonography characteristics of hypoechoic texture, micro calcifications, shape of taller than wider, internal vascularity, irregular margins, size >3cm and presence of lymphnodes. The ultrasonography test has 93.5% diagnostic accuracy to differentiate malignant from benign lesions. In this region thyroid lesions were predominantly benign and more common in females.