For the differentiation of benign from malignant thyroidal disease, ultrasound displays anatomic but not histologic features. Other visualization techniques can be used including isotope scanning (radioiodine, 99mtechnetium, 241americium fluorescence, 131cesium, 67gallium, 75selenomethionine, 201thallium, 32phosphorus, 99mTc-bleomycin, 197mercury, 133xenon), thermography, x-ray techniques (plain films, computed tomographic scan, xeroradiography, chest x-ray, barium swallow, lymphography, angiography), and thyroid hormone suppression. Needle biopsy can be done by core biopsy (Vim-Silverman and drill biopsy), large needle biopsy for histologic processing and fine needle aspiration for cytologic interpretation. The latter is the safest, most reliable, and most cost-effective technique currently available to differentiate between benign and malignant thyroidal disease and has great promise for the future.