Background: Fine-needle aspiration and cytology is the cornerstone of preoperative evaluation of thyroid nodules, but Fine-needle aspiration and cytology diagnostic performance has varied across different studies. Several published guidelines provide recommendations for selecting nodules for cytology based on US appearance and nodule size. Some US parameters have been associated with increased risk of malignancy; however no characteristic seems sufficiently reliable in isolation to diagnose malignancy. The incidental thyroid nodule is one of the most common incidental findings on imaging studies that include the neck. An incidental thyroid nodule is defined as a nodule not previously detected or suspected clinically, but identified by an imaging study (ultrasound, CT or MRI). Patients and Methods: A prospective study of 75 patients were collected from Jan. 2016 till march 2017 from hospital medical data included clinical, Ultrasound, Fine needle aspiration and cytology and histopathology report. For prospective FNA collection, patients were enrolled in an institutional review board-approved protocol and informed consent was obtained. Results: Of the 75 patients (62 female, 13 male) A considerable proportion (41.3%) of patients were suspected to be malignant the cytological study showed that (30.7%) of the patients had colloid goiter, (13.3%) had follicular cells, and (10.7%) had papillary cells. Regarding histological diagnosis, (53.3%) found to have colloid goiter. FNA had a relatively high sensitivity (81.8%) and specificity (77.5%) around one third (32.3%) of those suspected to have malignancy found to really have cancer, incident cancer were found Conclusion: By using the Thyroid Imaging Reporting and Data System guidelines, one can see a significant reduction in the number of thyroid nodules recommended for biopsy. False positive and false-negative results continue to present a challenge in the evaluation of thyroid nodules. Molecular testing studies are needed to more accurately refine FNA diagnosis in the cytologically indeterminate group where the majority of cases prove to be benign and surgery could be avoided.