Objective: To nd out the diagnostic accuracy of strain elastography in di erentiating between benign and malignant thyroid nodules taking cytology as a gold standard. Study Design: Descriptive study. Place and Duration of study: Radiology Department, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan, from February to July 2019. Methodology: A total of 110 patients aged 18-80 years of either gender having one or more solid nodules, in thyroid lobe on conventional ultrasound examination, were included. Patients with cystic nodules, nodules that constitute more than 75% volume of thyroid lobe and thyroid nodules with peripheral calci cation were excluded. All the patients then underwent strain ultrasound elastography with high-resolution unit equipped with a linear array probe which was centered at 7.5 MHz. Sonoelastographic ndings were correlated with cytology. Results: Overall sensitivity, speci city, positive predictive value, negative predictive value and diagnostic accuracy of sonoelastography in di erentiating between benign and malignant thyroid nodules taking cytology as gold standard was 90.0%, 90.0%, 91.53%, 88.24% and 90.0%, respectively. Optimal cuto to di erentiate between malignant and benign nodules for elasticity strain using ROC curve was 2.57. Area under the curve (AUC) was found to be 0.933 (0.879-0.987) p<0.001. Conclusion: Sonoelastography is the non-invasive modality of choice with high diagnostic accuracy in di erentiating between malignant and benign nodules.