TI-RADS Calculator

Total Score: -

TI-RADS Category: -

Risk of Malignancy: -

Recommendation: -

Thyroid nodules are common and occur in roughly 60% of adults by the time they reach the age of 60. While most are benign, discerning which nodules pose a malignancy risk is crucial for patient management. Enter the Thyroid Imaging Reporting and Data System (TIRADS), a standardized tool developed by the American College of Radiology (ACR). TIRADS evaluates thyroid nodules on ultrasound to determine malignancy risk, enabling consistent and reliable clinical decision-making.

Our Free TIRADS Calculator is designed to bridge the gap between complex scoring systems and practical, user-friendly application. 

Understanding the TIRADS Scoring System

TIRADS evaluates thyroid nodules based on five ultrasound features, assigning points to each characteristic. The total score categorizes nodules into TR1 (benign) through TR5 (high suspicion for malignancy). Here are the features considered:

1. Composition

  • Cystic or almost completely cystic: 0 points
  • Spongiform: 0 points
  • Mixed cystic and solid: 1 point
  • Solid or almost completely solid: 2 points
  • Why It Matters: Solid nodules lead to higher scores because they are more likely to be associated with malignancy.

2. Echogenicity

  • Anechoic: 0 points
  • Hyperechoic or isoechoic: 1 point
  • Hypoechoic: 2 points
  • Very hypoechoic (darker than the neck muscle): 3 points
  • Why It Matters: The echogenicity of the nodule compared to surrounding thyroid tissue can indicate malignancy.

3. Shape

  • Wider-than-tall (benign shape): 0 points
  • Taller-than-wide (suspicious shape): 3 points
  • Why It Matters: A taller-than-wide dimension often correlates with more aggressive pathology.

4. Margin

  • Smooth or ill-defined margins: 0 points
  • Lobulated or irregular margins: 2 points
  • Extra-thyroidal extension (invasion beyond the thyroid gland): 3 points
  • Why It Matters: Irregular or invasive patterns suggest more suspicious or potentially malignant nodules.

5. Echogenic Foci

  • None or large comet-tail artifacts (benign): 0 points
  • Macrocalcifications (coarse calcifications): 1 point
  • Peripheral (rim) calcifications: 2 points
  • Punctate echogenic foci (microcalcifications): 3 points
  • Why It Matters: Microcalcifications or punctate echogenic foci are strongly associated with malignancy.

TIRADS Categories and Risk Stratification

The final TIRADS score places the thyroid nodule into one of five categories:

  • TR1 (0 points): Benign (risk of malignancy 0.3%)
    • No follow-up required.
  • TR2 (2 points): Not Suspicious (risk of malignancy 1.5%)
    • No follow-up required.
  • TR3 (3 points): Mildly Suspicious (risk of malignancy 4.8%)
    • Perform Fine Needle Aspiration (FNA) if ≥2.5 cm or follow-up if ≥1.5 cm.
  • TR4 (4-6 points): Moderately Suspicious (risk of malignancy 9.1%)
    • FNA if ≥1.5 cm or follow-up if ≥1.0 cm.
  • TR5 (≥7 points): Highly Suspicious (risk of malignancy 35%)
    • FNA if ≥1.0 cm or follow-up if ≥0.5 cm.

For high-risk nodules (TR4-TR5), the results strongly influence clinical decision-making, such as recommending FNA or surgery.

How to Use Our Free TIRADS Calculator 2025

Our TIRADS Calculator offers healthcare providers an intuitive tool to calculate TIRADS scores effortlessly. Here’s how it works:

Step 1. Gather Ultrasound Data

Perform a thyroid nodule ultrasound and document key features (composition, echogenicity, shape, margin, and echogenic foci).

Step 2. Input Features Into the Calculator

Using the dropdown options or fields, input each characteristic of the nodule into the calculator interface.

Step 3. Generate Results

The calculator instantly calculates the total score, corresponding TIRADS category, malignancy risk, and recommended next steps (e.g., FNA or follow-up).

Step 4. Follow Recommendations

Refer to the TIRADS category-specific guidance to determine the recommended management approach.

Case Example

Case 1. Solitary nodule in a 45-year-old woman

  • Composition: Solid
  • Echogenicity: Very hypoechoic
  • Shape: Taller-than-wide
  • Margin: Lobulated
  • Echogenic Foci: Punctate
  • TIRADS Score:
  • Solid = 2 points
  • Very hypoechoic = 3 points
  • Taller-than-wide = 3 points
  • Lobulated = 2 points
  • Punctate echogenic foci = 3 points
  • Total: 13 points
  • TIRADS Category: TR5 (Highly Suspicious, 35% risk).
  • Recommendation: FNA for malignancy confirmation.

Why Use Our TIRADS Calculator

1. Standardized Reporting

Eliminates variability in ultrasound interpretation, ensuring consistency across clinicians.

2. Enhanced Accuracy

Factor in all five TIRADS features to derive clear, actionable results. 

3. Saves Time

Instant calculations save valuable time during busy clinical workflows. 

4. Educational Tool

Supports students and residents in mastering thyroid nodule assessment methods. 

5. Free and Accessible

Accessible anytime for healthcare professionals, saving unnecessary costs.

Take the Next Step in Patient Care

For healthcare professionals and medical learners grappling with thyroid nodule evaluations, Our Free Calculator maximizes accuracy and efficiency. Make informed decisions, reduce unnecessary interventions, and enhance patient outcomes with this innovative tool.

Start using the  Calculator today and revolutionize your clinical practice.