Background: Better and early prediction of malignant thyroid nodule, and sure differentiation from benign one, is crucial need to decrease the rate of non-indicated surgeries. The aim ofthe work: To find risk factors and predictors of malignancy in patients with thyroid nodule[s]. Patients and Methods: Fifty patients with thyroid nodule[s] were included. All patients were evaluated by history taking, clinical examination and laboratory investigations. Imaging studies included thyroid ultrasound [US]. All were also submitted to fine needle aspiration cytology [FNAC] before treatment by total or subtotal thyroidectomy.Excised tissues were sent to histopathological analysis. Results:The incidence of malignancy was 22.0%. both benign and malignant groups were comparable as patient characteristics, complaints except the significant increase in cosmetic disfigurement among patients with benign nodules [92.3% vs. 45.5%]. Patients with malignant nodules had a significant increase of ill-defined margins, intranodular vascularity and enlarged lymph nodes [72.7%, 63.6% and 72.7% vs 5.1%, 12.8% and 25.6% respectively]. Ill-defined margins, enlarged lymph node and high grade in FNAC were the predictors of thyroid malignancy. Conclusion:Predictors of malignant thyroid nodules are ill-defined edges, enlarged lymph node and high grade in FNAC. This helps clinicians to spare more benign cases from surgical interference.