Background: Thyroid nodule is new growth that forms a lump in any part of the thyroid gland. Identifying and evaluating thyroid nodules (whether benign or Malignant), is by physical examination, imaging technique like Conventional Ultrasound, Fine Needle Aspiration Cytology, Ultrasound Cintigraphy, and CT Scanning. The prevalence of palpable thyroid nodules is approximately 5% in women and 1% in men living in iodine-sufficient parts of the world as per different epidemiological studies Majority of nodules are benign and 10% contain Cancer and are solitary According to literature, treatment involves thyroidectomy, percutaneous ethanol injection. Solitary Thyroid nodules should be routinely excised due to high malignancy potential. Multiple nodules are commonly benign. The purpose of this study was to evaluate the protocol used to Diagnose and Manage thyroid nodules, including Benign and Malignant nodules. (Shrestha and Shrestha, 2014; Robert, 2015; Larijani et al., 2002) Broad Objective To evaluate the diagnosis and management approach of thyroid nodular goiter, among patients with thyroid enlargement at KCMC. Methodology The study was a Hospital based, Cross sectional descriptive study, involving 140 patients who were diagnosed with, and treated for thyroid nodules at KCMC from January 2013 to December 2014. A Purposive sampling technique was employed to obtain a study sample. Chi square test was used to determine the association between age, sex and malignancy. The patients information were obtained using Patients files ,Imaging results from Radiology Department, Histology results from Pathology laboratory. Results A total of 140 patients had thyroid nodules; Females were 130(92.9%). 46(45.5%) patients had solitary nodules and 33(32.7%) had multinodular goiter by Ultrasound. 42(48.3%) patients had benign nodular goiter by FNAB, 4(4.5%) had malignant nodules. Both Malignant Solitary and Multinodular goiter were higher in men by 10% each. Subtotal thyroidectomy was common in Benign MNG, but generally neartotal thyroidectomy was done in Multinodular goiter 28(52.8%); Males showed a higher risk to both Solitary nodular and Multinodular Malignancy. Rate of Multinodular malignancy was high in age >59years, but low risk. Age 25-39years had higher rate of malignant SNG (2.3%); but the chi square test showed that this age group(23-39 years)was not associated with the risk of malignancy. The prevalence of thyroid nodules was 54.1%.