Alternatively, you can use our tirads calculator to calculate tirads score and also to find recommendations.
TIRADS Table
| Criteria | Subcategories | Points |
|---|---|---|
| Composition | – Cystic/Spongiform: Benign | 0 |
| – Mixed Cystic & Solid | 1 | |
| – Solid or Mostly Solid | 2 | |
| – Solid (hyperechoic, isoechoic, or hypoechoic, depending on severity) | Higher points indicate increasing suspicion. | |
| Echogenicity | – Anechoic | 0 |
| – Isoechoic or Hyperechoic | 1 | |
| – Hypoechoic | 2 | |
| – Very Hypoechoic | 3 | |
| Shape | – Wider-than-Tall | 0 |
| – Taller-than-Wide | 3 | |
| Margin | – Smooth | 0 |
| – Ill-defined | 0 | |
| – Lobulated or Irregular | 2 | |
| – Extra-thyroidal Extension | 3 | |
| Echogenic Foci | – None | 0 |
| – Large Comet-Tail Artifacts | 0 | |
| – Macrocalcifications | 1 | |
| – Peripheral/Rim Calcifications | 2 | |
| – Punctate Echogenic Foci | 3 |
TIRADS Categories and Recommendations
| Category | Score | Suspicion Level | Recommendations |
|---|---|---|---|
| TR1 | 0 Points | Benign | No Fine Needle Aspiration (FNA) Required |
| TR2 | 2 Points | Not Suspicious | No FNA Required |
| TR3 | 3 Points | Mildly Suspicious | FNA if ≥ 2.5 cm; Follow-up if ≥ 1.5 cm |
| TR4 | 4–6 Points | Moderately Suspicious | FNA if ≥ 1.5 cm; Follow-up if ≥ 1 cm |
| TR5 | 7+ Points | Highly Suspicious | FNA if ≥ 1 cm; Follow-up if ≥ 0.5 cm |
This table organizes the criteria and corresponding scores more clearly, alongside actionable follow-up based on the TIRADS score. Let me know if you’d like further refinements!
What does TIRADS stand for?
TIRADS stands for Thyroid Imaging Reporting and Data System. It is a standardized system used to classify thyroid nodules based on their ultrasound features to assess the risk of malignancy.
What is the TIRADS rating system?
The TIRADS rating system assigns points to specific ultrasound characteristics of thyroid nodules, such as composition, echogenicity, shape, margins, and echogenic foci. These points determine a TIRADS category (TR1–TR5), indicating the likelihood of malignancy and guiding management decisions.
What are the TIRADS numbers?
The TIRADS system uses five categories:
- TR1 (Benign): No risk of malignancy.
- TR2 (Not Suspicious): Very low risk.
- TR3 (Mildly Suspicious): Low risk.
- TR4 (Moderately Suspicious): Intermediate risk.
- TR5 (Highly Suspicious): High risk.
What are the stages of TIRADS?
The stages correspond to the categories:
- TR1 (Benign): No action is required.
- TR2 (Not Suspicious): No action is required.
- TR3 (Mildly Suspicious): FNA or follow-up based on size.
- TR4 (Moderately Suspicious): FNA for nodules ≥1.5 cm or follow-up for smaller nodules.
- TR5 (Highly Suspicious): FNA for nodules ≥1 cm or follow-up for smaller nodules.
What is TIRADS 3 or 4?
- TIRADS 3 (Mildly Suspicious): Low malignancy risk (about 2-5%). Follow-up or FNA may be needed for larger nodules (≥2.5 cm).
- TIRADS 4 (Moderately Suspicious): Intermediate risk (about 5-20%). FNA is recommended for nodules ≥1.5 cm.
What is the difference between TIRADS and Bethesda?
- TIRADS: A scoring system based on ultrasound imaging to assess the risk of malignancy and guide FNA decisions.
- Bethesda: A cytology-based classification system used after FNA to categorize thyroid nodule biopsy results and estimate cancer risk.
Key Difference: TIRADS is pre-FNA (based on imaging), while Bethesda is post-FNA (based on cytology results).
What is the difference between TIRADS and ATA?
- TIRADS: Focuses on a point-based scoring system using specific ultrasound features for risk stratification.
- ATA (American Thyroid Association): Provides broader guidelines, including ultrasound features, management, and treatment recommendations for thyroid nodules and cancer.
Key Difference: ATA offers comprehensive management guidelines, while TIRADS focuses specifically on risk stratification using ultrasound.
What to do with TIRADS 4?
For TIRADS 4 (Moderately Suspicious):
- Perform FNA if the nodule is ≥1.5 cm.
- Consider ultrasound follow-up if the nodule is smaller (1–1.5 cm).
- Discuss risks and next steps with a healthcare provider.
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