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Background: Thyroid nodules (TN) are more frequent in the iodine-deficient region and the proportion of benign nodules is higher compared to areas with sufficient iodine intake. Objective: The aim of this study was to assess factors associated with malignant TN specially the EU-TIRADS ultrasound score in a Moroccan population with a high prevalence of iodine deficiency. Methods: In a prospective cross-sectional study, we enrolled outpatients referred for TN with fine needle aspiration biopsy (FNAB) according to EU-TIRADS 2017 classification. Malignancy of TN was defined by histological results indicating a thyroid malignancy on thyroid micro-biopsy or after surgical resection if indicated. Results: 225 participants with TN were enrolled. The median age was 54 (42.5 to 62) years-old. The prevalence of malignant TN was 8.9%. Malignant TN were significantly smaller than non-malignant ones (p = 0.008) and sub-centimetric TN were more frequent in malignant TN (25% vs 1.5%; p < 0.001). On multivariate analysis, male gender (OR : 9.33 ; 95% CI [2.02 ; 43.01]; p = 0,004) and EU-TIRADS score of 5 (OR : 55.6 ; 95% CI [9.34 ; 327.91] ; p < 0.001) were independent factors associated with malignant TN. The EU-TIRADS score of 4 was not associated to malignant TN. Conclusion: Our data suggest a trend of over-diagnosing indolent thyroid cancer. The EU-TIRADS score of 4 was not associated with TN malignancy. Considering clinical, accessory sonographic features, and size threshold for FNAB in EU-TIRADS 4 score TN may refine the diagnosis performance of this score in our population [ABSTRACT FROM AUTHOR]