Thyroid disorders are one of the common problems encountered in clinical practice with majority of them benign in nature. Thyroid cancer is a relatively rare malignancy representing only 1.5% of all cancer but it is the commonest endocrine cancer accounting for 92% of all endocrine malignancies.Objective: To assess the incidence of malignancy and its pathological aspects in 100 cases of thyroid swellings.Patients and methods: a prospective study of one hundred patients who were complaining from thyroid swelling and underwent thyroid surgery after complete evaluation, indications for operation are: (1) Malignant cases. (2) Suspicious cases by FNAC. (3) Enlarged thyroid gland causing pressure symptoms. (4) Toxic goitre after medical control. (5) Positive cervical lymph nodes for thyroid malignancy. All cases were operated upon in the of General Surgery department, Zagazig University Hospitals, from October 2009 to May 2011. Statistical analysis: SPSS version 19. Results: A total of 100 cases with thyroid swelling which underwent surgical removal. Of these, 23 (23%) were males and 77 (77%) were female. It was observed that the highest prevalence of thyroid swelling cases occurred in the age group 31–40 years (29%) while the lowest prevalence occurred in the age group under 20 years (1%). 8 cases (8%) were found to be malignant and the rest 92 cases (92%) were non- malignant thyroid swellings. Histologically, the highest incidence of carcinoma was Papillary carcinoma (5%) followed by follicular carcinoma (3%). Conclusion: (1) Although goitrous thyroid swelling is a common problem, thyroid malignancy is not a major issue. Among thyroid malignancies, papillary carcinoma is the most common histological type. (2) All thyroid swellings should be carefully examined and thoroughly investigated for suspicious lesions. All cases of goitre should be considered for surgery even if there is no suspicion of malignancy.,