The presence of psammoma bodies in a pathologic specimen or fine needle aspiration is highly suggestive of papillary carcinoma of the thyroid. We report three patients with pathologically benign hyperplastic thyroid nodules, all of whom had thyroid surgery because of the finding of psammoma bodies on fine needle aspiration biopsy. These data indicate that psammoma bodies are not pathognomonic of papillary cancer, and that their presence, in the absence of other cytologic criteria for malignancy, should not necessarily lead to immediate surgical exploration. If surgery is carried out, the approach should be limited and conservative, given the reduced likelihood of malignancy.