Thyroid nodules are common with a higher prevalence in women and the older population. They can be found in more than 50% of the older population. Malignancy risk is reported to be 7–15% depending on age, sex, radiation exposure history, and family history. Thyroid nodules can be detected either by palpation or incidentally by imaging done for irrelevant purposes. About 16% of chest CT scans show an incidental thyroid nodule. Subsequent ultrasound scans would evaluate the nodule size and characteristics. If the nodules meet the biopsy criteria based on TIRADS (Thyroid Imaging Reporting and Data Systems) criteria, referral for fine-needle aspiration biopsy (FNA) is necessary. This video delivers a thorough demonstration of the correct technique for ultrasound-guided thyroid FNA with rapid on-site cytology evaluation (ROSE).