What should you know?
ACR TI-RADS is a standardized ultrasound risk-stratification system for thyroid nodules. Points are assigned for composition, echogenicity, shape, margins and echogenic foci, producing a TR1–TR5 category.
A higher category means more suspicious imaging features, not a confirmed cancer diagnosis. Follow-up and biopsy recommendations depend on both the category and nodule size.
Common symptoms and signs
- TR1–TR2 indicate benign or low-risk patterns
- TR3 is mildly suspicious and TR4 moderately suspicious
- TR5 has highly suspicious ultrasound features
- Growth should be judged with standardized measurements
Diagnosis and the role of ultrasound
A useful report includes three nodule measurements, location, each scored feature and final category, while also assessing the remaining thyroid and cervical lymph nodes.
- Composition and echogenicity
- Taller-than-wide shape
- Margins and possible extension
- Macrocalcification, rim or punctate echogenic foci
Treatment and next steps
Size thresholds differ by category. A small TR5 nodule may initially be followed, while another nodule may need different care based on symptoms, risk factors and guideline criteria.
When is urgent care needed?
- Breathing or swallowing difficulty
- New persistent hoarseness
- Rapid growth or suspicious cervical lymph nodes