Fine-needle aspiration (FNA) biopsy is widely used in the evaluation of nodular thyroid disease. From January 1979 to May 1983, 100 patients underwent FNA biopsy at Wake Forest University Medical Center for evaluation of nodular thyroid disease. Forty-six underwent immediate thyroidectomy based upon clinical and cytologic criteria. Fifty-three patients identified as having benign atypical or normal cells initially were managed nonoperatively. An additional patient with Hürthle cell neoplasm diagnosed by cytologic evaluation refused surgery and is included in the group treated nonsurgically. This report concentrates on the characteristics and subsequent course of these 54 patients. Emphasis was placed on whether surgery was actually avoided or merely delayed by the results of FNA biopsy. Follow-up evaluation ranged from 16 to 92 months (mean, 57 months). Fifty-two (96%) patients had not been operated upon for thyroid disease during the follow-up period, and in none of the 52 had there developed new indications for surgery. The two (4%) patients who had undergone thyroidectomy proved to have benign disease. The authors conclude that with adequate clinical follow-up, FNA biopsy can accurately and appropriately guide the nonoperative management of nodular thyroid disease, and that the technique does spare patients the cost and risk of thyroidectomy, both initially and during subsequent follow-up evaluation.