Aim: Thyroid nodules are frequently encountered in clinical practice Fine-needle aspiration (FNA) cytology is a reliable method to assess malignancy potential, though most nodules are benign. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) standardizes ultrasound evaluation, aiding malignancy risk stratification and reducing unnecessary biopsies. Methods: This retrospective study analyzed 182 patients who underwent thyroid ultrasound and FNA between August 2023 and August 2024. Nodules were classified using the ACR TI-RADS and Bethesda systems. Chi-square and receiver operating characteristic (ROC) curve analyses assessed correlations between classifications. Results: The mean age was 49.77 years, with 159 females (87.36%) and 23 males (12.64%). Most nodules were categorized as ACR TI-RADS 3 (n = 120, 65.93%) and Bethesda 2 (n = 148, 81.32%), indicating benignity. Higher ACR TI-RADS scores correlated with increased malignancy risk, with ACR TI-RADS 5 nodules (n = 5, 2.75%) aligning with Bethesda 5 (n = 5, 2.75%). ROC analysis showed an area under the curve (AUC) of 0.93 for malignancy detection, demonstrating strong discriminatory power. Conclusions: ACR TI-RADS aligns well with Bethesda results, effectively stratifying thyroid nodule risk and reducing unnecessary interventions.