Background: Thyroid nodules are a common occurrence in the general population.Ultrasound provides a safe and fast sensitive method for the detection of thyroid nodules, and suspicious features can be used to guide further investigation/management decisions. However, given the financial burden on the health service and unnecessary anxiety for patients, it is unrealistic to biopsy every thyroid nodule to confirm diagnosis . Aim:This study aimed to develop a rational, cost-effective approach to ordering and interpreting imaging and diagnostic tests in the evaluation of the thyroid nodule. Methods: this was a cross-sectionalprospective study including all patients presented with thyroid nodules either clinically or incidentally discovered in thyroid clinic of endocrine unit in period between March 2019 to March 2022thyroid function test, thyroid ultrasound andFine needle aspiration cytology (FNAC) was done. Results: According to TI-RADS classification, 2, 7 and 32 nodules categorized as TI-RADS I, II and III were benign on FNAC with specificity of 100%. Therefore, the estimated decrease in unnecessary FNACs was 63.08%. Meanwhile, all nodules categorized as TI-RADS V (very suspicious) were confirmed to be malignant by FNAC with sensitivity, specificity, PPV and NPV of 100%. Conclusion: The sonographic features, severe hypo-echogenicity and micro-calcification can be used for diagnosis of malignancy. TI-RADS classification and thyroid cancer were associated; TI-RADS 3 and 2 are the most frequently noted classification of TNs in or study.