What Are the TIRADS Ratings?

The identification of thyroid nodules in certain individuals brought about the development of a rating system called Thyroid Imaging Reporting and Data System (TIRADS).

This rating system was invented by the American College of Radiology (ACR) and it represents the use of a standard means of adequately assessing thyroid nodules on the basis of ultrasound features.

This system allows a rating that enables nodules to be put into several different categories as related to the risk of malignancy associated with it.

More so, the rating system also ensures appropriate recommendations as regards the timely use of fine needle aspiration (FNA) or ultrasound follow-up of suspicious nodules, as well as recommendations to let be the nodules that are harmless.

In this article, you’ll be getting to understand the different TIRADS ratings alongside one or more related content.

Key Takeaways: What Are the TIRADS Ratings?

TIRADS stands for “Thyroid Imaging Reporting and Data System.”

Developed to standardize the evaluation and reporting of thyroid nodules using ultrasound.

Ratings range from TR1 to TR5, with TR1 being benign and TR5 highly suspicious for cancer.

Higher TIRADS score = greater cancer risk and a stronger recommendation for biopsy.

Used by radiologists to guide follow-up decisions and avoid unnecessary biopsies.

Helps improve communication between doctors and ensures consistent care.

For more information about this, check here and here.

The TIRADS ratings are categorized into five levels of suspicion named from TR1 to TR5. The different ratings include:

TR1: Nodules rated in this regard usually have a very low risk of malignancy and are generally known to be benign. They’ll often not require any further testing or follow-up.
TR2: Nodules rated in this regard also have a very low risk of malignancy and are generally not suspicious. They’ll also not require any further testing or follow-up.
TR3: Nodules rated in this regard have a low risk of malignancy and are generally known to be mildly suspicious. However, it may become necessary to follow up on these nodules with ultrasound monitoring or fine-needle aspiration (FNA) biopsy if they are larger than 2.5 cm.
TR4: Nodules rated in this regard have a high risk of malignancy and are generally known to be moderately suspicious. It’s recommended and necessary to do a further evaluation with an FNA biopsy to help ascertain the nature of the cancer.
TR5: Nodules rated in this regard have the highest significant risk of malignancy and are generally known to be highly suspicious. It’s strongly recommended and necessary to do a further evaluation with FNA biopsy since nodules usually come with malignant features as observed on ultrasound imaging.

For more information, check here and here.

What Features are used in TIRADS Ratings?

The various features being utilized in TIRADS ratings and in the evaluation of a thyroid nodule include:

Margins: These refer to the edges of the nodule. It may be smooth, irregular, or lobulated.
Shape: This refers to whether the nodule is taller-than-wide or wider-than-tall.
Vascularity: This refers to the observation of how blood flows in the nodule.
Composition: This refers to whether the nodule is solid, cystic, or mixed.
Echogenicity: This can either be hypoechoic or isoechoic. This refers to the comparison of how the nodules appear to the surrounding thyroid tissue.
Calcifications: These refer to the identification of either microcalcifications or macrocalcifications within the nodule.

Related:

FAQs About TIRADS Ratings

1. What is TIRADS?

TIRADS (Thyroid Imaging Reporting and Data System) is a classification system used by radiologists to assess thyroid nodules based on ultrasound features and estimate the risk of thyroid cancer.

2. What do the TIRADS categories mean?

TR1: Benign (0% risk)
TR2: Not suspicious
TR3: Mildly suspicious
TR4: Moderately suspicious
TR5: Highly suspicious

3. Why is TIRADS important?

It helps doctors decide whether a thyroid nodule needs a biopsy, follow-up imaging, or no action at all, reducing unnecessary procedures.

4. Who uses the TIRADS system?

Radiologists, endocrinologists, and primary care doctors use TIRADS to make informed decisions about thyroid nodule management.

5. Can a low TIRADS rating still mean cancer?

While rare, it’s possible. TIRADS helps estimate risk, but biopsy or follow-up imaging may still be needed based on other factors.

6. Does every thyroid nodule get a TIRADS score?

Typically, nodules seen on ultrasound are evaluated using TIRADS, especially if they are above a certain size or have suspicious features.

7. What happens if I have a TR5 nodule?

A TR5 rating suggests a high risk of cancer. Your doctor will likely recommend a fine-needle aspiration biopsy for further evaluation.

Conclusion

Now that you know what TIRADS ratings are, they work based on ultrasound features observed, with each feature being rated and the total score determining the TIRADS ratings.

Hence, getting your thyroid nodules rated will help you as an individual patient to ensure that you get adequate care while minimizing unnecessary procedures, thereby boosting your overall thyroid health.

Reference

Liang F, Li X, Ji Q, He D, Yang M, Xu Z. Revised Thyroid Imaging Reporting and Data System (TIRADS): imitating the American College of Radiology TIRADS, a single-center retrospective study. Quant Imaging Med Surg. 2023 Jun 1;13(6):3862-3872. doi: 10.21037/qims-22-1307. Epub 2023 May 15. PMID: 37284080; PMCID: PMC10240023. Retrieved from here
Hussein, M.A., Elesawy, Y.F., Ghoweba, D.E.A.AR. et al. Correlation of ultrasound features in the TIRADS scoring system with cytological findings in the FNAC of thyroid nodules and their association with the metabolic status. Egypt J Intern Med 36, 29 (2024). Retrieved from here
Risk for malignancy of thyroid nodules: Comparative study between TIRADS and US based classification system. Retrieved from here
Eleonora Horvath, Sergio Majlis, Ricardo Rossi, Carmen Franco, Juan P. Niedmann, Alex Castro, Miguel Dominguez, An Ultrasonogram Reporting System for Thyroid Nodules Stratifying Cancer Risk for Clinical Management, The Journal of Clinical Endocrinology & Metabolism, Volume 94, Issue 5, 1 May 2009, Pages 1748–1751. Retrieved from here
Zhuang, Y., Li, C., Hua, Z. et al. A novel TIRADS of US classification. BioMed Eng OnLine 17, 82 (2018). Retrieved from here

0 Shares