Introduction: Thyroid swelling is common, but differentiating benign from malignant nodules remains challenging. Clinical predictors and fine-needle aspiration cytology (FNAC) are key in preoperative evaluation, yet indeterminate cytology often leads to unnecessary surgery. Objective: To associate clinical and cytological predictors of malignancy in patients with thyroid swelling and develop a risk stratification model. Methods&Materials: This cross-sectional study included 50 patients undergoing thyroidectomy at Rajshahi Medical College Hospital (June-December 2014). Clinical, ultrasonographic, FNAC (Bethesda classification), and histopathological data were analyzed. Malignancy rates were compared using odds ratios, 95% confidence intervals, and Fisher’s exact test. Results: Malignancy prevalence was 14.0% (7/50). Extreme age (<20 or >50 years) had a 33.3% malignancy rate vs. 9.1% for ages 21 - 50 years (p = 0.02). Malignancy was higher in males (25.0%) than in females (11.9%), but this was not statistically significant (p = 0.31, descriptive only). Solitary nodules (26.7%) and solid nodules (20.0%) were associated with higher malignancy. FNAC demonstrated sensitivity 85.7%, specificity 100%, and NPV 97.7%; after excluding indeterminate Bethesda IV cases, accuracy was 98.0%. For Bethesda IV (follicular neoplasm, n = 6), overall malignancy was 16.7%; in an exploratory analysis, adding extreme age stratified risk to 50% (with extreme age) vs. 0% (age 21 - 50 years). Malignancy prevalence was 14.0% (7/50). Extreme age (<20 or >50 years) had a 33.3% malignancy rate vs. 9.1% for ages 21 - 50 years (p = 0.02). Malignancy was higher in males (25.0%) than in females (11.9%). Solitary nodules (26.7%) and solid nodules (20.0%) were associated with higher malignancy. FNAC demonstrated sensitivity of 85.7%, specificity of 100%, NPV of 97.7%, and accuracy of 98.0%. For Bethesda IV (follicular neoplasm, n = 6), overall malignancy was 16.7%; adding extreme-age stratified risk increased it to 50% (with extreme age) vs. 0% (age 21 - 50 years). Conclusion: Age extremes, male sex, solitary and solid nodules are associated predictors. FNAC has excellent diagnostic accuracy. An exploratory model combining Bethesda IV with age requires external validation before any clinical application.
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