Management of TI-RADS 2 Thyroid Nodules in Pregnancy
A TI-RADS 2 thyroid nodule in pregnancy requires no intervention beyond routine observation, as these nodules are benign by definition and do not require fine-needle aspiration, thyroid function testing, or any specific monitoring during pregnancy.
Understanding TI-RADS 2 Classification
- TI-RADS 2 nodules are definitionally benign lesions that include spongiform nodules or nodules composed of multiple microcystic components, which carry essentially no malignancy risk 1
- These nodules do not meet criteria for biopsy at any size, unlike higher-risk categories 2, 1
Recommended Management Approach
No Active Intervention Required
- No fine-needle aspiration is indicated for TI-RADS 2 nodules regardless of size, as the malignancy risk is negligible 2, 1
- Thyroid function testing (TSH) is not specifically required for TI-RADS 2 nodules unless the patient has symptoms of thyroid dysfunction or other clinical indications 3
- No ultrasound surveillance during pregnancy is necessary for confirmed TI-RADS 2 nodules 1
Pregnancy-Specific Considerations
- The approach to thyroid nodules in pregnancy should mirror that for non-pregnant patients, with evaluation focused on identifying potentially malignant lesions 4, 5
- All thyroid nodules should be evaluated during pregnancy according to ACOG guidelines, but this refers to determining their risk category, not performing invasive procedures on benign lesions 3
- Thyroid nodules may increase in size during pregnancy (particularly in the third trimester), but this physiologic change does not alter management of definitionally benign TI-RADS 2 nodules 6
Important Clinical Caveats
Ensure Accurate Classification
- Verify that the nodule is truly TI-RADS 2 and not misclassified; if there is any uncertainty about the classification or if suspicious features are present (solid hypoechoic appearance, irregular margins, microcalcifications, taller-than-wide shape), the nodule should be reclassified to the appropriate higher-risk category 1, 7
- If the nodule was classified as TI-RADS 2 but shows concerning features on review, it requires re-evaluation using proper TI-RADS criteria 2, 1
When to Reconsider
- If the nodule demonstrates rapid growth, develops new suspicious ultrasound features, or is associated with palpable cervical lymphadenopathy, re-evaluation with possible reclassification and FNA may be warranted even during pregnancy 8
- New symptoms such as compressive symptoms, hoarseness, or dysphagia should prompt clinical reassessment 5