Background: Fine needle aspiration with adequate cytological evaluation has contributed to reduction of unnecessary thyroid surgeries for benign nodules of up to 50 %. This study aimed to compare the diagnostic efficacy and accuracy between suction and non-suction technique of fine needle cellular biopsy of the thyroid nodules. Methods: This prospective study included patients with thyroid nodules warranting FNAC based on TIRADS classification. The selected nodules were aspirated under ultrasound guidance at least twice, using both FNA+P and FNA-P techniques. The adequacy and diagnostic value of the cytological samples were assessed by two blinded cytologists. Complications were recorded, and immediate complications were linked to specific needle passes. Results: The mean age was 32.08 ± 7.83 years. 47% of the subjects were younger than 30 years, 35% were between 31 and 40 years, and 18% were older than 40 years. There was a significant higher number of cases under the age of 30 years (p=0.002). 92% of the subjects were female and 8% were male. There was a significant difference in gender distribution, with more females than males included in the study (p < 0.001). Fine needle aspiration with suction showed higher sensitivity (97.53%), accuracy (97%), PPV (94.88) and NPV (97.46%) compared to non-suction technique. Both techniques had high AUC for predicting adequate diagnosis (p < 0.001). Conclusion: FNA with suction demonstrated significantly higher adequacy in diagnosis prediction compared to non-suction technique. Moreover, fine needle aspiration with suction showed higher sensitivity, accuracy, PPV, and NPV compared to the non-suction technique.