 Hello everyone. I am Dr. Palak Marfagya, second year radiology resident from SPKS Medical Institute and Research Centre. The title of my paper is Role of Sonography in Evaluation of Nodular Thyroid Lesions. Aims and Objectives. The aim of my study is to evaluate role of sonography in evaluation of thyroid nodules to differentiate a benign thyroid lesion from malignancy. In India, the prevalence of thyroid nodules is common, but thyroid cancer is rare and it is not possible for every patient with thyroid nodule to undergo biopsy to confirm diagnosis. Hence, sonographic grading by ACR-Tyrads helps in analyzing when the thyroid nodule needs affinity and follow-up. Background. Thyroid disorders have become widely prevalent in India despite fortification of salt with iodine. Thyroid disorders are more common in females. Majority of patients with thyroid disease present with midline neck swelling occasionally causing dysphagia and hoarseness of voids. The thyroid nodule is discrete lesion distinct radiologically from the normal type. It is the most common abnormality arising in the endocrine part of the body. Using latest sonographic techniques, evaluation of thyroid nodule as malignancy without affinity has risen to 90%. Evaluation of cervical lymph nodes also helps to determine the malignancy risk. Material and method. The study was done in 152 patients who came to sonographic department with suspicion of thyroid disorders with superficial high-frequency ultrasound probe. The ultrasound characteristics used in my exam were ecogenicity that is hyperechoic, irregularity in margins, microcalcification, cystic components and increased vascularity of thyroid gland as specified by ACR-Tyrads. In cases of thyroid cancer, the sonography reports were cross-matched with the histopathological biopsy report. Observations of ultrasonography. This is how a benign thyroid nodule looks like and this is how malignant thyroid nodule looks like. Benign colloid nodule. This is a benign colloid nodule which shows few specs of calcification for which there is no need of biopsy. Benign colloid nodule. Purely cystic, anarchoic structure seen in right lobe of thyroid, suggestive of benign etiology and there is no need of any biopsy. Types of thyroid carcinoma. There are four types of carcinoma of thyroid. First one is papillary. It is the most common, 60 to 70%. It's found, mostly it's found in young adults around 20 to 40 years of age. It has lymphatic spread to focal nodes and the prognosis is excellent. Second is follicular. It is 20 to 25% common, found in young to middle age group around 40 to 50 years of age. Spread is by bloodstream, especially to bones. Prognosis is good with radioiodine therapy. Third type is anoplastic. It is 10 to 15% common, found in elderly. It has aggressive and local extension and the prognosis is very poor. The fourth is medullary, which arises from C cells. It is only 5 to 10% common, found in elderly, but familial cases can occur. It has local lymphatic or spread by bloodstream. Prognosis is variable, but it is more aggressive in familial cases. Papillary carcinoma of thyroid. Papillary cell carcinoma showing microcalcifications detected on USG and on the HPE, it shows samoma bodies. Follicular carcinoma of thyroid. USG can differentiate follicular adenoma from follicular carcinoma as follicular carcinoma shows capsular breach, while follicular adenoma doesn't show thyroid breach of thyroid capsule. It is shown in the pictures below. Follicular carcinoma of thyroid confirmed by histopathology. Role of color Doppler. The Doppler shows increased vascularity, which is suggestive of malignancy. Results. In my case control study on 152 people with thyroid nodules, 36 were classified as tyrants 3, 4 or 5 in which 32 patients underwent surgical resection, of which 29 people had HPE-brewed thyroid carcinoma. Meaning the accuracy of sonography with thyroid scoring is 91% effective in diagnosing malignancy without effinacy. Conclusion. Ultrasonography with thyroid scoring is 91% effective in diagnosing malignancy without effinacy and has an advantage of no radiation and it is relatively, it has relatively easy availability. In hands of a good radiologist, thyroid nodules can be effectively evaluated for malignancy and even lymph node involvement could be detected accurately. Here are the references. Thank you.