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TIRADS-Calculator
A TIRADS calculator is a simple online tool. Here is all you need to know about this calculator.
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TIRADS is an abbreviation which stands for Thyroid Imaging Reporting and Data System. It is a scoring system used by radiologists who perform ultrasound scans on the thyroid gland of patients who have suspected growths/nodules on them. Based on the appearance of the thyroid gland on the scan, different features are noted & given points for variations. This score can be used to assess the risk of chances of possible malignancy (cancer) in the thyroid and the need to perform further testing on the gland in the form of a Fine Needle Aspiration Cytology (FNAC) or a wedge biopsy.
What is a TIRADS calculator?
A TIRADS calculator evaluates thyroid nodule cancer risk based on ultrasound features like composition, echogenicity, shape, margin, and echogenic foci. Each feature is scored, with the total score placing the nodule into a TIRADS category (TR1-TR5). Higher TIRADS levels indicate a greater malignancy risk, guiding decisions on biopsy or monitoring. A trained radiologist can use the calculator efficiently.
Why Use the TIRADS Calculator?
The TRIADS Calculator has several key benefits for trauma and emergency care:
Prioritises Patient Care: By quickly identifying high-risk patients, the calculator aids in triage, allowing for efficient prioritisation of care.
Supports Clinical Decision-Making: With an evidence-backed risk score, the TRIADS Calculator helps inform treatment pathways and interventions.
Enhances Resource Allocation: Knowing which patients require immediate attention in busy emergency settings helps with resource management, ensuring that critical care is available when needed.
Improves Patient Outcomes: Prompt identification of high-risk individuals allows for quicker, more targeted treatment, reducing mortality rates and improving recovery chances.
How to Use the TIRADS Calculator
Healthcare professionals can use the TIRADS Calculator by inputting specific patient details, including:
Patient’s Age and Gender
Vital Signs: Record heart rate, blood pressure, respiratory rate, oxygen saturation, and other relevant metrics.
Type and Mechanism of Injury: Specify if it’s blunt trauma, penetrating, or another form.
Glasgow Coma Scale (GCS) Score: Indicate the patient's level of consciousness and responsiveness.
After entering the information, the calculator provides a TRIADS score, representing the likelihood of severe outcomes. This score is then used to determine the most appropriate care pathway, including immediate surgical intervention, close monitoring, or intensive care.
TIRADS Categories
Every nodule visualised by ultrasound can be characterised based on its appearance in an ultrasound scan into the following 5 categories.
Composition
Echogenicity
Shape
Margin
Echogenic Foci
Each of these categories is counted separately and has a points system as follows.
Composition (choose 1)
| Criteria | Points |
|---|---|
| Cystic or almost completely cystic | 0 |
| Spongiform | 0 |
| Mixed cystic & solid | 1 |
| Solid or almost completely solid | 2 |
Echogenicity (choose 1)
| Criteria | Points |
|---|---|
| Anechoic | 0 |
| Hyperechoic or Isoechoic | 1 |
| Hypoechoic | 2 |
| Very hypoechoic | 3 |
Shape (choose 1)
| Criteria | Points |
|---|---|
| Wider than Tall | 0 |
| Taller than wide | 3 |
Margin (choose 1)
| Criteria | Points |
|---|---|
| Smooth | 0 |
| Ill-defined | 0 |
| Lobulated or irregular | 2 |
| Extrathyroidal extension | 3 |
Echogenic Foci (choose all that apply)
| Criteria | Points |
|---|---|
| None of the large comet-tail artefacts | 0 |
| Macrocalcifications | 1 |
| Peripheral (rim) calcifications | 2 |
| Punctate echogenic foci | 3 |
The next step is to add the points from all the categories.
Based on the score, the status of the nodule is categorised as follows:
0 points - TR1
2 points - TR2
3 points - TR3
4-6 points - TR4
7 or more points - TR5
TR1 indicates that the nodule is Benign (non-cancerous) and does not require an FNAC. This corresponds to 0.3 % risk of malignancy.
TR2 indicates that the nodule is Not Suspicious, and does not require an FNAC. This corresponds to 1.5 % risk of malignancy.
TR3 indicates a Mildly Suspicious nodule. An FNAC is recommended if the nodule size is more than 2.5cm. If it's between 1.5 and 2.5 cm, then periodic follow-up of the nodule's progression is done to watch for an increase in size. Follow-up intervals are 1,3 and 5 years from the first visit. This corresponds to a 4.8 % risk of malignancy.
TR4 indicates a Moderately Suspicious nodule. If the size is more than 1.5 cm, then FNAC is done. Follow-up is done if the size is between 1 and 1.5 cm. Follow up at 1, 2, 3, and 5 years. This corresponds to a 9.1 % risk of malignancy.
TR5 means Highly Suspicious. Here, an FNAC is done for any nodule over 1 cm in size. Those more than 1 cm are followed up closely. A 5-year yearly follow-up is recommended. This corresponds to a 35 % risk of malignancy.The maximum score is 17. The higher the score, the higher the risk of malignancy and the worse the prognosis.
If there are multiple nodules, all are categorised, and FNAC samples are the two with the highest TIRADS scores. These might not necessarily be the most extensive nodules. Follow-up examination forms a vital part of diagnosis and treatment. Some nodules with even a higher TIRADS score may not be feasible for an FNAC. These patients are closely followed up to look for significant enlargement. Significant enlargement is defined as a 50% increase in the volume or a more than 2mm/20% increase in two different dimensions of the nodule from previous findings.
Limitations Of A TIRADS Calculator
Here are some of the limitations of the TIRADS Calculator :
Ultrasonography results are subjective and depend on the radiologists' assessment of how the nodule looks when compared with the surrounding tissue and strap muscles of the neck. They also depend on the quality of the machine being used.
Pre-existing medical conditions like Hashimoto’s thyroiditis make it challenging to correctly interpret the ultrasonography findings. For example, a pattern with multiple hyper and hypoechoic patterns can be seen with Hashimoto’s and should not be a cause for concern.
Anechoic has a score of 0, while very hypoechoic has a score of 3. Both may need help to differentiate.
Points to remember while using the TIRADS calculator
| In case of | Select |
|---|---|
| Rim calcifications obscure the nodule completely | Composition - “solid” and Echogenicity - “isoechoic” |
| The Margin cannot be determined | Margin - “ill-defined” |
| Echogenicity cannot be determined | Echogenicity - “isoechoic” |
| The Composition cannot be determined | Composition - “solid” |
Always exercise caution while selecting any option with a higher score and make sure to cross-check your findings.
Frequently Asked Questions (FAQs)
Here’s a list of commonly asked questions and their answers related to a TIRADS Calculator.
Can the TIRADS score be used to confirm the diagnosis?
No, the TIRADS calculator is just an indicator of a thyroid nodule's benign or malignant status. Further investigations are needed to confirm a diagnosis and plan treatment.
Can anyone use a TIRADS calculator?
TIRADS scoring requires training; only a trained radiologist can assess the parameters.
Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.
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Roocha Kanade
Content Architect
Health Insurance content enthusiast who turns complex topics into easy, binge-worthy reads—fueled by SEO, creativity, and way too much chai! Loves juggling multiple projects, cracking impossible deadlines, and sprinkling humor into the mix. When not geeking out over digital trends, you'll find her lurking on Quora and Reddit, planning the next getaway, or passionately decoding all things health and insurance!
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Roocha Kanade
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Dr Nitin Kumar Gupta
SVP – Health Underwriting & Claims at Acko General Insurance
SVP – Health Underwriting & Claims at Acko General Insurance — With 20+ years of experience driving digital transformation and profitable growth, I am a seasoned Senior Insurance Executive specialising in Health, Life, Accident, and Disability insurance. Backed by an MBBS degree and advanced insurance designations (FLMI, FALU, FLHC, ACS, ARA), I bring a unique blend of medical expertise and deep insurance-domain leadership. My core strength lies in optimising underwriting and claims operations, enabling automation-led scalability for both large insurers and digital-first startups.
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SVP – Health Underwriting & Claims at Acko General Insurance
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