CA THYROID WITH METASTASIS
Findings and description-
Solid cystic anechoic/ isoechoic lesion is seen in right lobe of thyroid gland.
Multiple septations are seen within the lesion.
Solid component shows tiny calcifications within. Thyroid lesions is seen to extend beyond right lobe of thyroid gland
This lesion falls under TIRADS category – TR5 (Highly suspicious for malignancy)
Similar morphology lesions are seen along the right carotid vessels and IJV S/O metastatic lymph nodes.
Thyroid metastasis looks almost similar to the primary lesion.
The Thyroid Imaging Reporting and Data System (TIRADS) is a standardized system for assessing thyroid nodules on ultrasound to estimate the risk of malignancy and guide clinical management. It is commonly used to decide whether fine-needle aspiration (FNA) biopsy or follow-up is needed.
Key Features Assessed in TIRADS:
- Composition:
Cystic or almost completely cystic (0 points)
Spongiform (0 points)
Mixed cystic and solid (1 point)
Solid or almost completely solid (2 points)
- Echogenicity:
Anechoic (0 points)
Hyperechoic or isoechoic (1 point)
Hypoechoic (2 points)
Very hypoechoic (3 points)
- Shape:
Wider than tall (0 points)
Taller than wide (3 points)
- Margins:
Smooth (0 points)
Ill-defined (0 points)
Lobulated or irregular (2 points)
Extra-thyroidal extension (3 points)
- Echogenic foci:
None or large comet-tail artifacts (0 points)
Macrocalcifications (1 point)
Peripheral (rim) calcifications (2 points)
Punctate echogenic foci (3 points)
TIRADS Scoring and Risk Categories:
The features are scored, and the total determines the TIRADS category:
TR1: Benign (0 points) – No biopsy
TR2: Not suspicious (1 point) – No biopsy
TR3: Mildly suspicious (2-3 points) – Biopsy if ≥2.5 cm or follow-up
TR4: Moderately suspicious (4-6 points) – Biopsy if ≥1.5 cm or follow-up
TR5: Highly suspicious (≥7 points) – Biopsy if ≥1 cm
TIRADS is widely used because it reduces unnecessary biopsies while focusing on nodules with a higher likelihood of malignancy.
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