Composition (Choose 1) Cystic or almost completely cystic 0 points Spongiform 0 points Mixed cystic and solid 1 point Solid or almost completely solid 2 points

Echogenicity (Choose 1) Anechoic 0 points Hyperechoic or isoechoic 1 point Hypoechoic 2 points Very hypoechoic 3 points

Shape (Choose 1) Wider-than-tall 0 points Taller-than-wide 3 points

Margin (Choose 1) Smooth 0 points Ill-defined 0 points Lobulated or irregular 2 points Extrathyroidal extension 3 points

Echogenic foci (Choose all that apply) None or large comet-tail artifacts Macrocalcifications 1 point Peripheral (rim) calcifications 2 points Punctate echogenic foci 3 points

Add points from all categories to determine TI-RADS level

TR1 Benign No FNA

TR2 Not Suspicious No FNA

TR3 Mildly suspicious FNA if ≥2.5 cm Follow if ≥1.5 cm

TR4 Moderately suspicious FNA if ≥1.5 cm Follow if ≥1 cm

TR5 Highly suspicious FNA if ≥1 cm Follow if ≥0.5 cm*

YJTDT