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Thyroid nodules are often incidentally detected during physical examination, Doppler ultrasound of carotid artery, and other imaging modalities and there are many controversies about the management of these incidentalomas. We focused on incidental thyroid lesions during carotid ultrasound and evaluated their importance and suspected malignant features. Patients and methods: The thyroid gland was evaluated for any nodule(s) following carotid Doppler ultrasound in 290 patients. If there was an abnormal finding in the thyroid ultrasound, the patient was referred to an endocrinologist and after clinical and laboratory evaluation, fine-needle aspiration (FNA) biopsy was done if required. Results: We found an abnormal thyroid in 63 (21.8%) patients and 57 (19.6%) of patients had incidental thyroid nodules; these were mainly in women and older patients. Based on size and ultrasound findings of the nodules, 28 (44.4% of abnormal thyroids) patients were referred for fine-needle aspiration biopsy and 15 patients agreed with this procedure. Aspiration cytology showed two nondiagnostic samples (13.3%), 10 benign lesions (66.6%), two follicular cell lesions (13.3%), and one (6.6%) Hürthle cell neoplasm lesion. Conclusion: Thyroid evaluation during carotid ultrasound has little benefits.