Pathologists and cytotechnologists often provide immediate specimen adequacy evaluation of thyroid fine-needle aspirations (FNAs) to ensure that diagnostic material is obtained. We assessed the cost-effectiveness of this practice. All patients who had a thyroid FNA specimen accessioned at the Beth Israel Deaconess Medical Center, Boston, MA, during a 6-month period were included and divided into 2 groups: (1) with or (2) without immediate adequacy assessment. Specimen adequacy from each group was compared. The time spent to perform the adequacy assessment was recorded. Compared with group 2, group 1 had more specimens with diagnostic cellular material (67.2% vs 47.0%) and fewer specimens with suboptimal (23.3% vs 38.1%) or nondiagnostic cellular material (9.5% vs 14.9%) (P = .002). At the time of adequacy assessment, 98% (60/61) of the adequate specimens were obtained with 3 or fewer passes. The improved rate of diagnostic material was achieved at a cost of 220 minutes of cytologists' time per additional diagnostic specimen compared with group 2. It may be most cost-effective to routinely obtain 3 passes and to perform immediate adequacy assessment under special circumstances such as repeated procedures.