OBJECTIVE To describe various techniques for performing ultrasound-guided fine-needle aspiration (FNA) biopsy of thyroid nodules, with the intent of shortening the learning curve for physicians with interest in this new procedure. METHODS General principles and details of biopsy techniques and equipment are reviewed, and personal experience and preferences are described. RESULTS Real-time ultrasound guidance has technically refined the FNA biopsy technique by decreasing the number of inadequate biopsy specimens and increasing both the specificity and the sensitivity of this procedure. In addition to being cost-effective, well tolerated, and expedient, ultrasound-guided FNA biopsy has emerged as the most accurate method for evaluation of thyroid nodules. The success of the procedure depends on the experience of the person using these techniques. CONCLUSIONS For provision of optimal evaluation and management of thyroid nodules, endocrinologists should develop expertise in ultrasound-guided FNA biopsy and understand its advantages over conventional FNA biopsy.