Introduction: Thyroid swellings are one of the most common clinical findings in the neck region. It is important to diagnose the exact pathology prior to treating such conditions. FNAC is now an inexpensive, dependable and safe diagnostic test for the assessment of diffuse thyroid pathologies and thereby, avoiding the redundant surgeries. Ultrasound guided FNAC has the potential to reduce insufficiency rates and is considered as the optimal cytological method for diagnosis. Hence in our study we intend to compare the results of marked FNAC and ultrasound-guided FNAC of thyroid swellings and find out the diagnostic reliability of marked FNAC and ultrasound-guided FNAC using histological conclusion as the gold standard. Methods: 100 subjects with thyroid swelling were selected. They were randomly divided into two groups - marked FNAC and ultrasound-guided FNACs were performed in them respectively. The obtained findings were compared with the histopathological diagnosis. These patients subsequently underwent surgery and followed up for over 2 and half years. Results: Ultrasound guided FNAC results revealed 64% benign lesions and 29 % of malignant lesions, and marked FNAC revealed 54% benign and 20% malignant cases. Histological gold standard diagnosis included 57 % benign and 43 % malignant cases. Conclusion: Marked FNAC of thyroid swellings is more expedient and economic as related to ultrasound guided FNAC. Nevertheless, the diagnostic output in ultrasound guided FNAC is significantly more in terms of accurateness.