Background: Thyroid nodules are common in the population, and it's still unclear how to choose which thyroid nodules to send for fine needle aspiration cytology (FNAC). Objective: To evaluate the concordance between the ACR Thyroid Imaging Reporting and Data System (TIRADS) and fine-needle aspiration (FNA) based cytology reports using UK RCPath Thy classification in patients with thyroid nodules, aiming to decreasing the unnecessary fine-needle aspiration biopsy (FNAB) of thyroid nodules. Patients and methods: This retrospective cross-sectional study was conducted on patients who were referred to Menoufia University Hospitals for thyroid gland sonography and FNA with sonography guidance. Eighty patients were enrolled in this study. Results: This study involved 80 patients, 92.5 % were females and 7.5% were males with a mean age of 45.5±13.5. Sixty percent of the patients had TIRADS 3, 35% had TIRADS 4 and 5% had TIRADS 5. Fifty seven percent of the patients had Thy 2, 16.25 % had Thy 3 (3 cases were Thy3a and 10 cases were Thy 3f) and 26.25 % were Thy 4. Risk of malignancy was 14.5%, 35.7% and 100% for TIRADS 3, TIRADS 4 and TIRADS 5, respectively. Twenty-one cases were positive for malignancy by Thy classification, 71.4% (15/21) of these cases was positive for malignancy by TIRADS classification with significant p-value (0.001) and 0.365 Kappa agreement. Conclusions: This study revealed that there was a fair agreement between TIRAD and Thy system in evaluation of thyroid nodules and both are necessary for proper management of patients. TIRADS can be relied upon for follow up of patients and in cases of small nodules not accessible for FNAC.