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
Ultrasound findings must be interpreted together with symptoms, examination and, when needed, laboratory or other imaging results. An image alone should not be used for self-diagnosis or self-treatment.
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.
Management is individual and depends on age, symptoms, imaging findings, other health conditions and pregnancy plans. Medication or a procedure should be selected with the appropriate clinician.
When is urgent care needed?
- Breathing or swallowing difficulty
- New persistent hoarseness
- Rapid growth or suspicious cervical lymph nodes
Related reading
- Thyroid nodules — when is ultrasound needed?
- Thyroid ultrasound
- Enlarged lymph nodes — causes and diagnosis
When should you consult radiologist Lana Ezieshvili?
Radiologist Lana Ezieshvili performs targeted ultrasound examinations, describes findings using standard imaging criteria and explains the report in clear language.
If you have symptoms, a referral or need follow-up imaging, use the form below to book a visit with Lana Ezieshvili. Timely, appropriately selected imaging can reduce uncertainty and help determine the right next step.
This article is for education and does not replace medical advice. Seek urgent care for severe or rapidly worsening symptoms.