Is to evaluate the accuracy of thyroid imaging reporting and data system (ACR-TIRADS) and the Bethesda system for reporting cytopathology (TBSRCP) classifications in identifying or ruling out thyroid malignancy in relation to the gold standard (post-surgical pathology). This is a Cross-sectional study included 573 patients with single or multiple thyroid nodules. Patients were evaluated using the TIRADS and the TBSRCP classification. The data were correlated to the post operative pathology in a cohort of patients who underwent surgery 77/573 (13.4%), and to the relevant clinical features of the patients. There were 545 (95.1%) patients euthyroid, 24 (4.1%) were hypothyroid, and only 4 (0.8%) patients were hyperthyroid. There were 419 (73.1%) patients had benign nodules (Bethesda II), 115 (20.1%) patients were intermediate (Bethesda III, IV), and 39 (6.8%) patients had Bethesda V, VI. There were 420 (73.3%) patients TIRADS 2,3 and 153 (26.7%) patients were TIRADS 4,5. There was a significant concordance between the Bethesda and TIRADS in the diagnosis of thyroid nodules (K=14.9%, P<0.001). Thyroid malignancy associated significantly with microcalcification and interrupted halo, while macrocalcification and complete halo type were significantly detected in benign nodules (P=0.041 and P=0.005; respectively). The TBSRCP could significantly detect malignant thyroid nodules with a sensitivity, specificity, PPV and NPV of 64.1% 98.1% 85.0% 94.1%; respectively (K=88.2%, P<0.001). While the TIRADS classification achieved a sensitivity, specificity, PPV, and NPV of 63.5%, 76.0%, 84.6%, and 50.0%; respectively (K= 34.8%, P=0.001). The TIRADS and TBSRCP are essential primary steps for evaluating thyroid nodules and both are complimentary to each other's. Hence, it is recommended that each patient had thyroid nodules do both steps before rushing to surgery. Highly suspicious TIRADS classification TR4 and TR5 need further evaluation by fine needle aspiration cytology (FNAC).