TIRADS Calculator

The five TIRADS criteria for the calculation are:

1) Composition: How cystic or solid the nodule is.
• Spongiform: Composed predominantly (>50%) of small cystic spaces. Do not add further points for other categories.
• Mixed cystic and solid: Assign points for predominant solid component.
• Assign 2 points if composition cannot be determined because of calcification.

2) Echogenicity: Determined by whether the ultrasound is anechoic, isoechoic, or hypoechoic.
• Anechoic: Applies to cystic or almost completely cystic nodules.
• Hyperechoic/isoechoic/hypoechoic: Compared to adjacent parenchyma.
• Very hypoechoic: More hypoechoic than strap muscles.
• Assign 1 point if echogenicity cannot be determined.

3) Shape: Established by the physical appearance of the nodule.
• Taller-than-wide: Should be assessed on a transverse image with measurements parallel to sound beam for height and perpendicular to sound beam for width.
• This can usually be assed by visual inspection.

4) Margin: Established by the physical appearance of the nodule.
• Lobulated: Protrusions into adjacent tissue.
• Irregular: Jagged, spiculated, or sharp angles.
• Extrathyroidal extension: Obvious invasion = malignancy.
• Assign 0 points if margin cannot be determined.

5) Echogenic foci: Related to the calcifications.
• Large comet-tail artifacts: V-shaped, > 1 mm, in cystic components.
• Macrocalcifications: Cause acoustic shadowing.
• Peripheral: Complete or incomplete along margin.
• Punctate echogenic foci: May have small comet-tail artifacts.

Using ultrasound imaging will help discover the features of the nodule. Each feature corresponds to a number of points which are used to calculate a TIRADS score for the thyroid nodule.

TIRADS Score and Biopsy Decision

The TIRADS Calculator adds up the points to score the TIRADS level, ranging from benign to highly suspicious. A lower point total indicates that the thyroid nodule is benign or less suspicious while a higher point total indicates a suspicious nodule that may be malignant.

Depending on the TIRADS score from the TIRADS Calculator, fine needle aspiration (FNA) may be used to test for a malignant thyroid nodule. A thyroid FNA is a simple biopsy procedure that uses a small needle to collect a sample from the nodule.