TIRADS Calculator for Thyroid Nodules

Disclaimer: The author makes no claims of the accuracy of the information contained herein; this information is for educational purposes only and is not a substitute for clinical judgment. This calculator is based upon the American College of Radiology (ACR) TIRADS classification, but this calculator is not officially endorsed by the ACR.

Spongiform: Composed predominantly (>50%) of small cystic spaces. No further points are added for other categories.

Mixed cystic and solid: Assign points for predominant solid component.

Anechoic: Applies to cystic or almost completely cystic nodules.

Hyperechoic/isoechoic/hypoechoic: Compared to adjacent parenchyma.

Very hypoechoic: More hypoechoic than strap muscles.

Shape should be assessed on a transverse image with measurements parallel to sound beam for height and perpendicular to sound beam for width.

Lobulated: Protrusions into adjacent parenchyma.

Irregular: Jagged, spiculated, or sharp angles.

Extrathyroidal extension: Obvious invasion of adjacent soft tissue or vascular structures.

Large comet-tail artifacts: V-shaped, >1 mm, in cystic components.

Macrocalcifications: Cause acoustic shadowing.

Peripheral calcifications: Complete or incomplete along margin.

Punctate echogenic foci: Nonshadowing, may have small comet-tail artifacts.

TIRADS categories:
  • TR1 Benign (0 pts)
  • TR2 Not Suspicious (2 pts)
  • TR3 Mildly Suspicious (3 pts)
  • TR4 Moderately Suspicious (4-6 pts)
  • TR5 Highly Suspicious (≥7 pts)

FNA no more than 2 nodules with the highest TIRADS point scores at a time.

Follow no more than 4 nodules with the highest TIRADS point scores at a time.

Tessler FN, Middleton WD, Grant EG et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017; 14: 587-595

Grant EG, Tessler FN, Hoang JK et al. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol. 2015; 12: 1272-1279

Some benign patterns of Hashimoto's thyroiditis are not included in the TIRADS classification (e.g. "white knight" = uniformly hyperechoic nodule, "giraffe hide" = hyperechoic areas separated by hypoechoic bands).

Virmani V, Hammond I. Sonographic patterns of benign thyroid nodules: verification at our institution. AJR Am J Roentgenol 2011; 196:891-895