Thyroid fine needle aspiration (FNA) is among the most commonly performed non-gynaecologic cytologic procedures and the single most effective tool for guiding the initial management of a patient with a thyroid nodule. Its acceptance as a reliable preoperative test relies on its high sensitivity and specificity. The recently developed Bethesda System for Reporting Thyroid Cytopathology, has advanced the field by promoting a standard reporting terminology for thyroid aspirates. In addition, it allows communication with the referring physician to occur in terms that are unambiguous, reproducible, and clinically helpful.