December 30, 2022

Understanding a Thyroid Ultrasound Report of a Nodule: The TI-RADS (TR) Score!

Getting a thyroid ultrasound for a thyroid nodule is VERY common. The main concern is whether thyroid cancer may be present which peaks in women around age 40-50 years and in men usually around age 60-70 years. However, thyroid cancer can occur at any age. Given many patients are able to obtain a copy of their ultrasound reports, it may be educational to understand what is being stated beyond the obvious size description.

The KEY information patients should look for in an ultrasound report of the thyroid gland is the TI-RADS or TR score for each nodule.

Based on the thyroid nodule characteristics, the thyroid ultrasound report will classify each nodule on a scale from 1-5. Known as TI-RADS or Thyroid Imaging Reporting And Data System, this scale provides an estimate of cancer risk (abbreviated as TR in most ultrasound reports).

Current published results as of 2017 provides the following risk of cancer for each TR level.

  • TR1: 0.3%
  • TR2: 1.5%
  • TR3: 4.8%
  • TR4: 9.1%
  • TR5: 35%

Current medical guidelines of what to do next based on the TR results are as follows:

  • TR1: no needle biopsy required
  • TR2: no needle biopsy required
  • TR3: if >1.5 cm, repeat ultrasound at 1, 3, and 5 years; if >2.5cm, perform needle biopsy
  • TR4: if >1.0 cm, repeat ultrasound at 1,2, 3, and 5 years; if >1.5cm, perform needle biopsy
  • TR5: if >0.5cm, repeat ultrasound every year for 5 years; if >1.0cm, perform needle biopsy

Now these are just medical guidelines. For many patients having a nodule classified as TR3-TR5, a needle biopsy is often performed regardless of the size (for peace of mind).

In the end, it is up to the patient how to proceed based on this information. Endocrinologists are the doctors who are considered medical thyroid specialists. Most ENTs and general surgeons (though not all) can also deal with thyroid nodules.

As always, you can talk to your doctor for more information.


Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. (2017) Journal of the American College of Radiology : JACR. 14 (5): 587-595

Multiinstitutional Analysis of Thyroid Nodule Risk Stratification Using the American College of Radiology Thyroid Imaging Reporting and Data System. (2017) American Journal of Roentgenology. 208 (6): 1331-1341.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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