Objective: It is well recognized that incidence of thyroid disease is increasing in Saudi Arabia and varies in geographical areas of Saudi Arabia. This study was aiming to evaluate the patterns of thyroid pathology in Al Kharj region, which is a rural agricultural area in central Saudi Arabia with relatively large (3.1%) population. Methods: The retrospective study was designed covering period from 2012 to 2016, which include only patients, who received surgical treatment for the various thyroid pathologies. All data was collected from Department of Surgery at King Khaled Hospital (KKH), which is the university hospital, serving over 600,000 population of Al Kharj region. 92 thyroidectomies performed for various thyroid disorders where analyzed. Result: The incidence of thyroid disease for females in Al Kharj region was estimated as 2.7/100.000 of population per year comparing to males of 0.4/100.000 respectively.  Female to male ratio of 6.7:1 was observed in relation to the overall thyroid pathologies. The mean age of all studied cases was 41.3 years ranging from 19 to 77 years. The majority of the thyroid diseases was in the age group 20-50 years (79.3%). Cancerous lesions were found in 35 cases (38%) and presented mainly as papillary or follicular carcinomas with the female to male ratio of 10.5:1. Theprevalence of thyroid cancer in Al Kharj region in current study was 1.1/100.000 of population per year for females and 0.1/ 100.000 of population per year for males respectively. Conclusion: This study showed that in central rural province of Saudi Arabia females are dominantly affected by thyroid pathologies. The female to male ratio requiring surgical intervention was higher in Al Kharj region compared to the other Saudi Arabian areas. Incidence of thyroid pathology and prevalence for thyroid cancer was significantly higher in females compare to male population.