From the Research
The TIRADS score for this thyroid nodule is 4 points, which classifies it as a TIRADS-4 (moderately suspicious) nodule. This score is calculated by adding points for various ultrasound features: 1 point for solid composition (hypoechoic nodule), 0 points for being well-defined (sharply circumscribed), 2 points for hypoechogenicity, 1 point for microcalcifications, and 0 points for being wider-than-tall.
Key Features of the Nodule
- The nodule is hypoechoic
- It has few punctate microcalcifications
- It is sharply circumscribed
- It measures 7.1mm x 6.1mm x 7 mm For a TIRADS-4 nodule measuring 7.1 x 6.1 x 7 mm (which is less than 1.5 cm), fine needle aspiration (FNA) biopsy is recommended if the nodule is ≥ 1 cm 1. Since this nodule is smaller (approximately 0.7 cm), follow-up ultrasound in 1 year would be appropriate rather than immediate FNA. The TIRADS scoring system helps stratify thyroid nodules based on their risk of malignancy, with higher scores indicating greater risk. This particular nodule has some concerning features (hypoechogenicity and microcalcifications) but its small size and well-defined margins are more reassuring features.
Clinical Implications
- The presence of microcalcifications is suspicious for papillary thyroid carcinoma (PTC), particularly in young patients 2
- The nodule's small size and well-defined margins are reassuring features, but regular follow-up is still necessary to monitor for any changes
- The TIRADS scoring system is a useful tool for stratifying thyroid nodules based on their risk of malignancy, and can help guide clinical decision-making 3, 4, 5