From the Research
For a TIRADS 3 thyroid nodule with normal TSH and no symptoms, I recommend ultrasound follow-up in 1-2 years, as this approach is supported by the most recent and highest quality study 1. No immediate biopsy or treatment is needed as TIRADS 3 nodules have a low risk of malignancy. The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) has been shown to effectively categorize thyroid nodules and guide management decisions 1.
Some key points to consider in the management of TIRADS 3 thyroid nodules include:
- If the nodule is smaller than 1.5 cm, some guidelines suggest that follow-up can be extended to 3-5 years or potentially discontinued if the nodule remains stable 2.
- During follow-up appointments, the nodule should be assessed for changes in size, echogenicity, borders, and vascularity.
- If the nodule grows significantly (typically defined as an increase of 20% in two dimensions or at least 2 mm increase in the largest dimension), develops suspicious features, or if symptoms develop (such as difficulty swallowing, voice changes, or neck discomfort), then further evaluation with fine needle aspiration biopsy may be warranted 3.
- No medication is required for asymptomatic nodules with normal thyroid function.
- The patient should be educated about monitoring for symptoms such as neck pressure, difficulty swallowing, or voice changes, which would prompt earlier reassessment 4, 5.
It's worth noting that different guidelines may have varying recommendations for the management of thyroid nodules, but the ACR TI-RADS system has been shown to be effective in reducing unnecessary biopsies while still identifying malignant nodules 5. Ultimately, the decision to perform a biopsy or other interventions should be based on individual patient factors and clinical judgment.