BACKGROUND Fine Needle Aspiration Cytology (FNAC) is a simple procedure to evaluate thyroid swelling. In addition to this, thyroid function tests and tests for auto-antibodies like Anti-Thyroid Peroxidase antibody (Anti-TPO) also play an important role to diagnose thyroid diseases. But there are a very few studies, which have focused on a combination of FNAC findings and anti-TPO level to evaluate thyroid swelling. The aim of this study was to find out the correlation between FNAC findings and Anti-TPO antibody level in patients presenting with palpable thyroid swelling. MATERIALS AND METHODS This analytical observational study included 75 patients presenting with thyroid swelling without any history of thyroid related drug intake or surgery. The FNAC done by non-aspiration technique and findings were correlated with histopathology where surgical specimens were available, specially to confirm the diagnosis of follicular or papillary neoplasm. The anti-TPO antibody level was measured by microplate enzyme immunoassay. RESULTS Most of the non-neoplastic lesions were below 40 years of age. This study also revealed marked female preponderance (85.3%), both in non-neoplastic (83.6%) and neoplastic (88.2%) group of thyroid lesions. Mean Anti-TPO antibody level (IU/mL) in autoimmune thyroiditis group including Hashimoto's thyroiditis and lymphocytic thyroiditis is 203; in other non-neoplastic group including colloid, thyrotoxic and adenomatoid goitre is 86; whereas in neoplastic group the level is 32.22. Statistically, autoimmune thyroiditis group has significantly higher Anti-TPO level compared to other non-neoplastic group (p= 0.04) and neoplastic group (p= 0.01). But there is no significant difference of mean Anti-TPO level between neoplastic (value 32.22 IU/mL) and overall non-neoplastic group (value 121.7 IU/mL), as p value is 0.07. CONCLUSION A high anti-TPO antibody level in autoimmune thyroiditis (Hashimoto's and lymphocytic thyroiditis) has got a definite clinical significance in addition to FNAC in context to diagnostic and therapeutic protocol, as both cases are immunological in origin. But Anti-TPO antibody level does not have any significant role in differentiating other non-neoplastic lesions like colloid and adenomatoid goitre from neoplastic lesions of thyroid gland.