The thyroid gland is the largest endocrine gland in the human body, with a specific butterfly-shaped appearance located in the lower, front part of the neck. Thyroid hormones, which it creates and secretes into the bloodstream, directly affect the work of almost every one of our cells. These are thyroxine – tetraiodothyronine T4, triiodothyronine T3, and calcitonin. The thyroid hormone T4 contains four and T3 three iodine atoms, and for their production, it is essential iodine from food.

With the TI-RADS calculator, you can help with defining and creating guidance with fine-needle aspiration (FNA) and follow-up it. Also, you can find on our website the other health calculators, such as Blood Sugar Converter, Body Fat Percentage Calculator, and Cholesterol Ratio Calculator.

Thyroid Imaging Reporting and Data System – Definition

The system aims at the risks associated with thyroid lesions. During ultrasound examinations of the thyroid gland, radiologists encounter the problem of reporting nodules. It is recommended to use the TI-RADS system for solving these problems. Most of the recorded nodules are benign.

These phenomena are widespread and are not unknown in the world of medicine. A key segment of early detection of this condition is an ultrasound scan. With an ultrasound scan, the doctor can further determine whether it is necessary to perform a thyroid biopsy. The system involves the classification of formed thyroid nodules following five levels of assessing the risk of developing thyroid cancer.

Graphic presentation of TI-RADS 
Graphic presentation of TI-RADS 

What is a TI-RADS Score?

Each criterion for defining thyroid nodules carries a certain number of points. We distinguish five scoring criteria. The higher the end result, the higher the level of malignant cells. In the following, we will state which criteria you should observe, and if there is a more significant number of nodules, you should examine those with the highest sum of points in detail.

TI-RADS Score – How to use a calculator?

We will take as an example that you have identified a mixed cystic type of thyroid nodule with all other values from the five categories as follows:

  • composition: mixed cystic (1 point)
  • echogenicity: isoechoic (1 point)
  • shape: wider than taller (0 points)
  • margin: extra-thyroidal extension (3 points)
  • echogenic foci: macrocalcifications and peripheral / rim calcifications (3 points)

The total number of points is 8, it is a TI-RADS category level 5, and the percentage of risk of malignant cell formation is 35%.

Our calculator can help you with this calculation. Like all our other calculators, this calculator is elementary to use. In the indicated fields, you can select those options that are recognizable in your case. After that, the calculator will show you the total score and explain which TI-RADS level is in question and the probability of malignancy.

TI-RADS Criteria

The established criteria are based on a five-part system of separate summation of points. Each of the five levels or elements has certain doubts. The maximum number of points you can achieve is 17. We can mark the first criterion as TR1, and it is a benign type of thyroid nodule that does not require an FNA biopsy. FNA is an abbreviated name for the process of performing a fine needle biopsy with which a certain number of cells are collected and sent for further analysis. The collected sample may show possible signs of cancer cells. The second criterion is marked with TR2 and is not a suspicious criterion, and an FNA biopsy is also not required.

The third level criterion (TR3) is slightly suspicious and implies specific monitoring of the found thyroid nodules to avoid the formation of thyroid cancer. Level 4 nodes (TR4) are moderately suspicious and require detailed FNA monitoring or biopsy, while level 5 (TR5) nodes are highly questionable and require annual checks and biopsies.

TI-RADS Score Interpretation

The first category refers to the composition of nodules, and the following possibilities are listed:

  • cystic / completely cystic / spongy: 0 points
  • mixed cystic and solid: 1 point
  • solid or almost completely solid: 2 points

The second category refers to echogenicity, i.e., the ability to reflect waves in the surrounding tissue. Simply put, when examining if nodules have formed, you can see on the screen. Accordingly, the following options are listed:

  • anechoic: 0 points
  • hyperechoic/isoechoic: 1 point
  • hypoechoic: 2 points
  • very hypoechoic: 3 points

The third category takes into account the shape of the nodule, which you can mainly estimate by the value of the transverse plane, and the following possibilities are listed:

  • wider than height: 0 points
  • more than width: 3 points

The fourth category defines the margin of the nodule so that you can choose the following options:

  • smooth / poorly defined: 0 points
  • lobulated / irregular: 2 points
  • extrathyroid extension: 3 points

All four mentioned categories are questions where you can choose only one offered answer or option. The next, and also the last category for evaluation is the one that includes echogenic foci where you can select more options:

  • nothing / great comet tail artifact: 0 points
  • macrocalcification: 1 point
  • peripheral margin calcification: 2 points
  • punctate echogenic foci: 3 points


What is ACR TI-RADS?

ACR stands for American College of Radiology, while TI-RADS stands for Thyroid Imaging Reporting and Data System. It is an assessment and determination system for monitoring lesions or the occurrence of thyroid nodules.

What does a TR5 thyroid nodule mean?

TR5 thyroid nodule denotes a measure for thyroid nodules. These are the five levels of TI-RADS, where TR5 represents very suspicious nodes. In most cases, nodules from this level are non-cancerous.

What are the warning signs of thyroid problems?

Some early warning signs that something is wrong with your thyroid are feeling tired, sudden weight fluctuations, slow heart rate with increased heart rate, severe anxiety, premature hair loss, muscle aches, or swallowing problems.

Can a 4 cm thyroid nodule be benign?

The fact is that most of all identified thyroid nodules are benign. According to certain studies conducted on the respondents, a tiny percentage of them with nodules of 4 cm or more were malignant after the analysis.