Abstract Background: The evaluation of thyroid nodules poses a challenge. Gray-scale ultrasound is excellent for the detection and characterization of thyroid nodules, but the accuracy for the differentiation between benign and malignant lesions based on single criteria is low. Aim of Study: To assess the diagnostic value of elastog-raphy in the evaluation of thyroid nodules. Patients and Methods: This study was performed on 25 thyroid nodules in 25 adult patients (>18 years of age) of both sexes, referred to a private center from Internal Medicine, Endocrinology, Surgery and Oncology Clinics between Feb-ruary 2017 to October 2019. Results: Ultrasound Elastography (USE) is a reliable noninvasive diagnostic procedure for evaluating dominant thyroid nodules. According to elastography grade, 60% nodules were benign and 40% were malignant. The benign histology of soft nodules on qualitative elastography can be predicted with a satisfactory level of certainty. In cases of hard lesions, the predictive probability for a malignant finding is very high. The semi-quantitative Elasticity Ratio (ER) is a useful index in the differential diagnosis of thyroid nodules since it can provide quantitative information about the stiffness of the nodules however ER ratio calculation did not provide additional data to the qualitatively assessed elastography scores, which still remains the USE reference parameter. Conclusion: Elastography is undeniably a useful techno-logical advance in imaging of thyroid nodules but as with any other imaging modality it has its drawbacks. To overcome these limitations, it should always be performed by an expe-rienced operator who is familiar with its potential pitfalls and its results should always be interpreted in conjunction with findings of the B-mode sonography.