Thyroid nodules are common pathologies detected in thyroid gland. A thyroid nodule is the manifestation of a wide range of thyroid diseases, some benign and others malignant. Currently, the use of imaging methods has increased the diagnosis of asymptomatic nodules. Ultrasound studies of the population have reported a nodular thyroid disease rate of nearly 67% in elderly women. Most of these nodules are benign, and the incidence of malignancy is low (3–7%). Purpose To evaluate the role of vascular pattern and spectral wave forms and resistivity and pulsatility indices to differentiate between malignant and benign features. Patients and methods A total of 40 patients who were presented with thyroid nodules scheduled for surgery and preoperative fine-needle aspiration cytology were examined in a prospective way. G?ray-scale and color Doppler patterns were used to rank each thyroid nodule on a scale from 0 to 4 as follows: none, solely perinodular, accompanied by per-nodular prominence, accompanied by intranodular prominence, and only intranodular, respectively. Final diagnosis (benign or malignant) was confirmed by pathological correlations. Results Value of malignancy in thyroid nodules with a mean resistivity index of 0.72±0.13 is found to be significantly higher than with benignity (0.60.0.08). Conclusion Duplex Doppler parameters are helpful in distinguishing malignant from benign thyroid nodules.