How to Calculate TIRADS Score

The Thyroid Imaging Reporting and Data System (TI-RADS) is a very vital tool that’s utilized by endocrinologists, radiologists, and other healthcare professionals.

It’s a standardized and straightforward scoring system that is used to run necessary assessments on thyroid nodules identified in the course of undergoing an ultrasound investigation on an individual.

The use of TIRADS in thyroid nodules diagnosis, treatment, and management is very crucial in helping to distinguish the nodules that are harmless from those that may become a threat.

Furthermore, its usage is also essential in determining if the fine needle aspiration (FNA) biopsy and any other follow-up procedures on the lesion are required, so as to avoid unnecessary biopsies, especially on benign nodules.

In this article, you’ll get to understand the procedure of calculating the TIRADS score that is crucial in using points based on ultrasound characteristics to place nodules into different categories as regards their risk of malignancy.

The criteria for TIRADS are on the basis of some elements which are counted separately. So the higher the score, then the more severe is the prognosis.

The Thyroid Imaging Reporting and Data System (TIRADS) is also carried out on the basis of ultrasound features and in TIRADS scoring system, each of the features is allocated an actual point value.

So the sum of these point values ascertains the TIRADS score which is from 1 to 5. However, if you have multiple lesions, pick up the samples of any two that has the highest TIRADS score. Note that the highest point limit is 17.

You can score and count all the points using this format:

Ultrasound feature: Echogenicity

Anechoic: 0 points

Hyper- or isoechoic: 1 point

Hypoechoic: 2 points

Very hypoechoic: 3 points

Ultrasound feature: Echogenic foci

None/Large comet-tail artifact: 0 points

Macrocalcifications: 1 point

Peripheral/rim calcifications: 2 points

Punctate echogenic foci: 3 points

Ultrasound feature: Composition

Cystic or completely cystic/Spongiform : 0 points

Mixed cystic and solid: 1 point

Solid or almost completely solid: 2 points

Ultrasound feature: Margin

Smooth/Ill-defined: 0 points

Lobulated/irregular: 2 points

Extra-thyroidal extension: 3 points

Ultrasound feature: Shape (Consider the transverse plane)

Wider than tall: 0 points

Taller than wide: 3 points.

Now that you’ve allocated points to the individual features, you can calculate the total points and put the nodule into any of the five TIRADS category to specifically identify the risk of malignancy associated with the nodule:

TR1 (TI-RADScategory1): 0 points: Nodule is ‘Benign’: Fine needle aspiration (FNA) and other follow-up procedures not required.
TR2 (TI-RADS category 2): 2 points: Nodule is ‘Not Suspicious’: Fine needle aspiration (FNA) and other follow-up procedures not required.
TR3 (TI-RADS category 3): 3 points: Nodule is ‘Mildly Suspicious’: Fine needle aspiration (FNA) and other follow-up procedures are required especially if the nodule is 2.5 cm or larger.
TR4 (TI-RADS category 4): 4 to 6 points: Nodule is ‘Moderately suspicious’: Fine needle aspiration (FNA) and other follow-up procedures are required. Here, the risk of malignancy is high.
TR5 (TI-RADS category 5): 7 points or more: Nodule is ‘Highly suspicious’: Fine needle aspiration (FNA) and other follow-up procedures are required. Here, the risk of malignancy is higher.

Conclusion

Now that you’re familiar with how to calculate the TI-RADS score, it’s easier for you as an individual patient and even your healthcare providers to take a standard approach in investigating your nodule’s risk of malignancy and make adequate decisions that will help to manage your condition.

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