Background: Preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been associated prognostically in a few cancers. However, the role of these parameters as an adjunct with fine needle aspiration cytology (FNAC) in thyroid nodules is not determined. Objective: To evaluate if these parameters can be used as an adjunct in determining malignancy in thyroid nodules. Materials and methods: A retrospective study of 309 patients from July 2016 to July 2018 undergoing surgery for thyroid nodule was included. Their automated counts with NLR and PLR values were calculated. Receiver operator characteristic (ROC) curve was constructed for NLR and PLR to calculate cutoff, which was used to compare FNAC with histopathology in Bethesda category III and category IV between benign and malignant groups. Results: A total of 309 were included, with a mean age of 38.53 years (range: 10–80 years). Female: male was 261 (84.5%): 48 (15.5%). Benign thyroid nodules (n = 247, 79.9%), of which lymphocytic thyroiditis were 39, and malignancy (n = 62, 20.1%). Median NLR was 2.03, and median PLR was 82.74, which were taken as cutoff; there was a statistically significant difference between benign and malignant nodules (p < 0.001) for both. Similarly, at these cutoff values, Bethesda category III did not show any significant difference between benign and malignancy (p = 0.24), whereas Bethesda category II and IV had statistical significance between benign and malignancy for NLR (p < 0.001 and 0.04, respectively) but not for PLR (p = 1). Conclusion: NLR can be used as an adjunct with FNAC in suspecting malignancy in thyroid nodules.