Background: Thyroid nodules (TNs) are commonly encountered in clinical settings. Many professional organizations have adopted and published ultrasound-based risk stratification systems (RSSs) as a tool for standardized reporting and evaluation. The American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) Committee in 2017 proposed a white paper with a novel risk stratification system that classifies TNs into 5 morphologic categories on the basis of their ultrasonographic features (echogenicity, composition, margin, shape, and echogenic foci). These features are described and assigned points to obtain a total score that determines the thyroid nodule's TR risk levels (from TR1 to TR5). Objective: The aim of the current study was to assess the value of the ACR Thyroid Imaging Reporting and Data System (ACR-TIRADS) Lexicon in predicting the nature of different thyroid nodules. Patients and methods: A total of 102 subjects (90 female and 12 males; age between 18 and 77 years) with 130 thyroid nodules with a definitive cytopathologic diagnosis on the basis of US-guided FNAB and/or surgery results were enrolled. The mean age was 41.03 (SD 13.09) years, with ages ranging between 18 and 77 years. Our study was carried out between November 2020 and October 2022. Result: The ACR-TIRADS US lexicon's predictive ability in thyroid nodules' risk stratification was assessed. The overall accuracy, sensitivity, specificity, NPV, and PPV were 83.08%, 94.34%, 75.32%, 95.08% and 72.46%, respectively. Conclusions: In everyday practice, ACR-TIRADS classification is a non-invasive, safe, reliable, and applicable tool for evaluating thyroid nodules, standardizing report structure, and reducing inconsistencies with thyroid nodules' interpretation.