Aim To study cytology of various Thyroid lesions based on Bethesda system and to evaluate diagnostic accuracy of cytology by comparing it with histomorphological diagnosis whenever available. Materials and method In this study Fine needle aspiration cytology of 330 patients of clinically palpable thyroid were evaluated from June 2019 to December 2021 and categorised according to TBSRTC. 38 patients underwent surgical management in our hospital. Sensitivity, specificity, positive predictive value, negative predictive value reported under bethesda system were obtained by comparing the cytological and histopathological diagnosis where ever possible. Result The distribution of various categories from 330 evaluated thyroid nodules was as follows: 2.73% Non Diagnostic, 83.03% Benign, 0% Atypia of undetermined significance, 9.70% FN, 0.61% Suspicious for malignancy and 3.94% malignant. Sensitivity, specificity, positive predictive value, negative predictive value was 100, 60, 94.29 and 100% respectively. The diagnostic accuracy was calculated to be 94.73%. Conclusion There is a clearcut distinction between the two ends of the spectrum of non-neoplastic and neoplastic lesions of thyroid. Diagnostic accuracy of Bethesda system for reporting cytopathology for better clinical management is proven by the present study.