TI-RADS Calculator

Category: Other Health
- June 22, 2025
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The Thyroid Imaging Reporting and Data System (TIRADS) is a standardised classification system used to assess thyroid nodules based on ultrasound features. This calculator helps determine the TIRADS category and fine needle aspiration (FNA) recommendations.

Nodule Composition

Echogenicity

Shape

Margin

Echogenic Foci

Nodule Size

Enter the largest dimension of the nodule

Additional Information

About TIRADS

The Thyroid Imaging Reporting and Data System (TIRADS) is a risk stratification system that uses sonographic features to classify thyroid nodules and guide management decisions. It helps standardise thyroid nodule evaluation and reduce unnecessary biopsies while ensuring appropriate follow-up for suspicious lesions.

TIRADS Categories
  • TR1 (Benign): Purely cystic nodules - 0 points
  • TR2 (Not Suspicious): Very low suspicion - 2 points
  • TR3 (Mildly Suspicious): Low suspicion - 3 points
  • TR4 (Moderately Suspicious): Intermediate suspicion - 4-6 points
  • TR5 (Highly Suspicious): High suspicion - ≥7 points
Key Ultrasound Features
  • Composition: Solid nodules are more suspicious than cystic
  • Echogenicity: Hypoechoic nodules carry higher risk
  • Shape: Taller-than-wide orientation suggests malignancy
  • Margin: Irregular or lobulated margins increase suspicion
  • Echogenic Foci: Punctate echogenic foci (microcalcifications) are concerning
Clinical Applications
  • Risk Stratification: Categorises nodules by malignancy risk
  • Biopsy Decision: Guides when FNA is recommended
  • Follow-up Planning: Determines surveillance intervals
  • Communication: Standardises reporting between radiologists and clinicians
  • Quality Assurance: Provides consistent evaluation criteria
Limitations
  • Observer Variability: Subjective interpretation of some features
  • Size Considerations: Very small nodules may be difficult to characterise
  • Clinical Context: Family history and other factors not incorporated
  • Population Differences: Validation primarily in certain populations

Disclaimer: This TIRADS calculator is for educational purposes only and should not replace clinical judgement or professional medical evaluation. TIRADS assessment should always be interpreted in the context of clinical findings, patient history, and other relevant factors. All thyroid nodule evaluations should be performed by qualified healthcare professionals. This tool is not intended for diagnostic purposes.

What Is the TIRADS Calculator?

The TIRADS (Thyroid Imaging Reporting and Data System) Calculator is a decision-support tool used to assess thyroid nodules based on ultrasound features. It helps healthcare professionals determine the potential risk of malignancy and whether a fine needle aspiration (FNA) biopsy is recommended. This aids in efficient diagnosis, minimises unnecessary procedures, and improves communication between radiologists and referring clinicians.

Purpose and Benefits

This tool evaluates several characteristics of a thyroid nodule—such as its composition, echogenicity, shape, margins, and echogenic foci—to calculate a risk score. Based on this score, the tool assigns a TIRADS category from TR1 (benign) to TR5 (highly suspicious).

  • Risk Stratification: Quickly identifies which nodules may need further testing
  • FNA Recommendations: Offers guidance on whether a biopsy is appropriate
  • Follow-Up Planning: Suggests when to schedule future evaluations
  • Detailed Breakdown: Explains how each ultrasound feature contributes to the overall risk

Formula

Total Points = Composition + Echogenicity + Shape + Margin + Echogenic Foci

Each feature adds a specific number of points based on its appearance in the ultrasound. The total points determine the TIRADS category and influence biopsy decisions.

How to Use the Calculator

The calculator is simple to use and requires only basic clinical inputs:

  1. Select Nodule Features: Choose one option under each category—Composition, Echogenicity, Shape, Margin, and Echogenic Foci.
  2. Enter Nodule Size: Provide the maximum diameter of the nodule in mm or cm.
  3. Optional Input: Enter the patient's age for additional context.
  4. Click "Calculate TIRADS": The tool instantly displays the TIRADS category, risk of malignancy, FNA guidance, and follow-up advice.

Understanding the TIRADS Categories

  • TR1: Benign (0 points) – No follow-up needed
  • TR2: Not Suspicious (2 points) – Observation only
  • TR3: Mildly Suspicious (3 points) – Follow-up recommended
  • TR4: Moderately Suspicious (4–6 points) – FNA if ≥1.5 cm
  • TR5: Highly Suspicious (≥7 points) – FNA if ≥1.0 cm

Who Should Use This Calculator?

This tool is useful for:

  • Clinicians reviewing ultrasound results
  • Radiologists looking to classify nodules consistently
  • Medical students and trainees learning nodule assessment

How It Helps

The TIRADS Calculator supports decision-making by standardising thyroid nodule evaluation. It reduces unnecessary biopsies, supports accurate diagnosis, and promotes clear communication in clinical practice—just like tools such as the GFR Calculator for kidney function or the Corrected Calcium Calculator for serum calcium adjustments.

FAQs

What is TIRADS?

TIRADS stands for Thyroid Imaging Reporting and Data System. It's a method to classify thyroid nodules based on ultrasound features.

Why is the TIRADS score important?

It helps estimate the risk of cancer in a thyroid nodule and determine whether a biopsy is needed.

What does the calculator consider?

It considers five ultrasound features: composition, echogenicity, shape, margin, and echogenic foci.

Does nodule size affect the recommendation?

Yes. The size of the nodule determines whether a biopsy is needed for TR3 to TR5 categories.

Is this tool for patients?

No. This tool is intended for use by healthcare professionals. It should not replace clinical evaluation.

Final Note

Like Other clinical tools—such as the Body Surface Area Calculator for dosing or the Child-Pugh Calculator for liver function—the TIRADS Calculator simplifies complex assessments. However, it should always be used in conjunction with clinical judgment and patient-specific factors.