Thyroid Nodule Detected on Ultrasound
Placeholder lead: nodule found, baseline sonographic traits recorded.
- ~50%: Nodule prevalence (placeholder: adults by high-res US)
- ~5–15%: Malignant fraction (placeholder: of evaluated nodules)
- 6: Key traits assessed (placeholder: composition to foci)
- US: Imaging modality (placeholder: grayscale + Doppler)
Baseline characteristics captured
Placeholder text: size, composition, echogenicity, shape, margin, foci noted.
TI-RADS Feature Scoring — Building the Point Total
Placeholder lead: five feature categories accumulate into one score.
- 2 pts: Composition max (placeholder: cystic to solid)
- 3 pts: Echogenicity max (placeholder: anechoic to very hypoechoic)
- 3 pts: Margin max (placeholder: smooth to extrathyroidal)
- 3 pts: Foci max (placeholder: none to punctate)
Point accumulation across categories
Placeholder text: each feature adds points toward the total score.
TSH Level Checked — Ruling Out an Autonomous Nodule
Placeholder lead: TSH distinguishes autonomous from typical nodules.
- 0.4–4.0: Normal TSH range (placeholder: mIU/L reference)
- Autonomy: Low TSH implies (placeholder: possible hot nodule)
- Scintigraphy: Next test if low (placeholder: radionuclide uptake scan)
- Low: Hot nodule cancer risk (placeholder: rarely malignant)
Why TSH changes the pathway
Placeholder text: suppressed TSH reduces biopsy priority for that nodule.
Management Pathway — Category × Size Threshold
Placeholder lead: category and size together set the next step.
- ≥25mm: TR3 biopsy threshold (placeholder: follow at ≥15mm)
- ≥15mm: TR4 biopsy threshold (placeholder: follow at ≥10mm)
- ≥10mm: TR5 biopsy threshold (placeholder: follow at ≥5mm)
- Not indicated: TR1–TR2 biopsy (placeholder: regardless of size)
Reading the decision matrix
Placeholder text: locate category row and size column for the action.
Outcome — Observation, Suppression, or Biopsy
Placeholder lead: final pathway balances sensitivity and biopsy burden.
- Minimize: Unnecessary biopsy goal (placeholder: avoid over-testing)
- Maximize: Cancer detection goal (placeholder: catch true malignancy)
- 1–2 yr: Routine follow-up interval (placeholder: repeat ultrasound)
- Selected cases: Suppression use (placeholder: benign nontoxic goiter)
Balancing sensitivity and burden
Placeholder text: pathway chosen to limit unneeded procedures.