1. TIRADS Classification
TIRADS, or the Thyroid Imaging Reporting and Data System, is a system used to assess the malignancy risk of thyroid nodules based on ultrasound imaging features. It helps determine the appropriate management and follow-up for each nodule. Different organizations use slightly different TIRADS classifications, but the most commonly used ones include:
- ACR TIRADS - 2017
- EU-TIRADS - 2017
- K-TIRADS - 2016
Currently, Vinmec International General Hospital uses the most complete and updated ACR TIRADS classification (American College Of Radiology Thyroid Imaging Reporting and Data Systems). The classification is based on five imaging features: composition, echogenicity, shape, margin, and calcification pattern. Based on these characteristics, thyroid nodules are categorized from TIRADS 1 to 5, with each category suggesting a different risk level for malignancy. This classification helps determine the necessary follow-up or biopsy (FNA) recommendations.
- TIRADS 1: Benign. No biopsy (FNA) needed.
- TIRADS 2: Not suspicious. No biopsy (FNA) needed.
- TIRADS 3: Low suspicion. Biopsy (FNA) is recommended if the nodule is ≥ 2.5 cm. Follow-up if nodule ≥ 1.5 cm.
- TIRADS 4: Moderate suspicion. FNA is recommended if the nodule is ≥ 1.5 cm. Follow-up if nodule ≥ 1 cm.
- TIRSDAS 5: High suspicion. FNA is recommended if the nodule is ≥ 1 cm. Follow-up if nodule ≥ 0.5 cm.
2. Symptoms of TIRADS 3 Thyroid Nodule
Typically, individuals with TIRADS 3 thyroid nodules also experience similar symptoms to those who have general thyroid nodules: Those symptoms are often discovered incidentally during routine health checkups or while investigating other conditions because it usually lack distinct clinical symptoms. In rare cases, when the nodule is large, patients may experience compressive symptoms such as difficulty swallowing, shortness of breath, coughing, or hoarseness. Some patients may also notice a visible mass in the neck that moves while swallowing.
3. Diagnosis of TIRADS 3 Nodule
Thyroid Ultrasound: Ultrasound is the primary tool for determining the nature, location, size, and number of thyroid nodules. It also helps assess lymph nodes in the neck and classify whether a nodule is benign or malignant. The ultrasound assessment includes five key characteristics: composition, echogenicity, shape, margin, and calcification pattern to classify the nodule as TIRADS 1 through TIRADS 5. A TIRADS 3 nodule typically shows features such as a solid or predominantly solid structure, isoechoic or hyperechoic, smooth margins, and no microcalcifications.
Blood Tests: Blood tests for FT4 and TSH are used to assess thyroid function. Normal results are within reference ranges for these hormones. If the results are outside normal ranges, additional tests may be required, such as thyroid antibodies, thyroglobulin, or calcitonin levels.
After reviewing ultrasound results, blood tests, and the patient's medical history, a doctor will decide whether a Fine Needle Aspiration (FNA) biopsy is needed. For TIRADS 3 nodules larger than 2.5 cm, FNA is recommended. For smaller TIRADS 3 nodules, regular follow-up once a year with ultrasound is typically advised.
4. Treatment of TIRADS 3 Nodules
The treatment approach for TIRADS 3 thyroid nodules depends on the specific case:
Benign Nodules, Small Size: These are usually monitored without surgery. Regular follow-up with ultrasound is recommended, initially annually, and later extending to every 2-5 years. If there is significant growth such as more than 50% volume increase or a minimum growth of 3 mm in the largest dimension, or if new abnormalities appear on ultrasound, or the appearance of suspicious cervical lymph nodes… further evaluation is necessary. Additionally, depending on the specific case, the doctor will have a tailored management plan for the thyroid nodule.
Benign Nodules, Large Size: Large nodules over 2.5 cm that cause cosmetic concerns or compressive symptoms (such as difficulty swallowing, choking, or shortness of breath) may require intervention. Two options are available: surgery or radiofrequency ablation (RFA). RFA has advantages in reducing nodule size, is quick, effective, minimally invasive, and has fewer side effects, as it is performed with local anesthesia.
Malignant Nodules: The risk of malignancy in TIRADS 3 nodules is low (about 4.8%). Malignancy is confirmed through FNA biopsy. Further treatment depends on the pathology report. For papillary thyroid carcinoma (with favorable characteristics such as size < 1 cm, confined to the thyroid without capsule invasion or lymph node metastasis), surgery, RFA can be an option. For other types of thyroid cancer, further treatment will depend on surgical findings.
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