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TIRADS Calculator

The TIRADS Calculator is a scoring system that uses ultrasound features such as composition, echogenicity, shape, margin, and echogenic foci to determine how suspicious a thyroid nodule is of malignancy. It is an online resource for the Thyroid Imaging Reporting and Data System (TIRADS), complete with images and descriptions of different ultrasound features. The TIRADS Calculator was developed to reduce the overdiagnosis of thyroid cancer and the number of biopsies performed on benign nodules. In practice, the TIRADS Calculator produces a TIRADS score, which is a useful decision aid to determine whether or not a biopsy is appropriate.

TIRADS Calculator

TIRADS Calculator

Bilrubin (Total)










TIRADS Criteria

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.

Learn more on the BackTable VI Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on TIRADS Calculator and how to build your practice by listening to the BackTable VI Podcast, reading exclusing BackTable Articles, and following the work of our Contributors.

Pathology 101: Solid Advice for Percutaneous Biopsies
Ep 422 Pathology 101: Solid Advice for Percutaneous Biopsies with Dr. Andrew Sholl
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Disclaimer: The Materials available on are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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