Thyroid ultrasonography was performed on a combined series of 108 patients over a four-year period. Ultrasonography enabled superb visualisation of the neck, specifically the thyroid, and discriminated solitary from diffuse thyroid abnormalities and segregated these into cystic, solid or 'complex' patterns. Sonographic-pathological correlation was obtained in 38 cases, consisting of 14 follicular adenomas, 11 goitres, 3 Hashimoto thyroiditis, 6 colloid cysts and 4 carcinomata; the clinical course confirmed 11 cases of Graves' disease for a total of 49 confirmed cases. The sonographic patterns lack histological specificity; however, a pattern recognition approach can be developed to better select patients for surgery. Such an approach appears suitable in tropical Africa, where radionuclide imaging may not be available. Diagnostic ultrasound is affordable, versatile and efficacious and without any known biological risks. A plea is made for its increased availability.