TIRADS 3 Thyroid Nodule Treatment: All You Need To Know!

Thyroid nodules are spherical or irregular solid formations in the thyroid gland and are easily visible in the base of the neck. Typically, thyroid nodules are benign and asymptomatic. However, in some cases, these nodules can be malignant and carry the risk of cancer. In this regard, the Thyroid Imaging Reporting and Data System (TIRADS) comes in handy.

The TIRADS organises the thyroid nodule according to adjunctive ultrasound characteristics. It uses a scoring system to predict the chances of cancer from a thyroid nodule. The American College of Radiology (ACR) developed this technology to help doctors understand when to perform a biopsy on a thyroid nodule and when to leave it alone. In short, this technology helps in cancer risk assessment and further treatment planning. 

TIRADS 3: Definition and Characteristics

TIRADS 3 nodules are considered benign nodules with a 2% to 5% risk of cancer. These nodules have unique ultrasound features that can be used to differentiate them from more malignant types.

Some of the key features of TIRADS 3 nodules include:

• Well-defined margins: The periphery of the nodule has a well-defined margin.
• Oval shape: Most nodules have a wider-than-tall figure, which means their width is greater than their height.
• Minimal internal vascularity: Reduced blood supply within the nodule.
• Predominantly solid or partially cystic composition: There can be fluid-filled areas in some nodules.

Significance of TIRADS Scoring in Thyroid Cancer Risk

TIRADS helps doctors strategise the risk of malignancy in thyroid nodules by assigning a score to it. This structured framework based on ultrasound features helps determine which nodules need further investigation, such as fine-needle aspiration (FNA), and which can be monitored without intervention.

Now, in terms of TIRADS 3, the chance of the nodule being malignant is roughly around 5%. Therefore, the doctors will opt for regular follow-up and active monitoring to see how this nodule develops and, based on that, take the necessary actions.

Diagnostic Evaluation of TIRADS 3 Nodules

Proper evaluation will lead to an accurate or simplified diagnosis and subsequent management of the condition. In this regard, patients should keep the following points in mind: 

• Role of Ultrasound in TIRADS Assessment

Ultrasonography is the primary diagnostic process currently used for TIRADS classification. It provides a detailed picture of the thyroid gland, including its size, shape, echo density, margin characteristics, and blood flow. As for TIRADS 3 nodules, the first examination and follow-up monitoring are mainly based on ultrasound tests.

• Fine Needle Aspiration Biopsy (FNAB) Indications

On the other hand, FNAB is not the standard diagnosis process for TIRADS 3 nodules because their malignant risk is low. However, FNAB may be indicated if:

1. The nodule demonstrates increased progression over the years
2. During follow-up, other high-risk features are observed
3. The patient has a record of radiation exposure or has any family record of thyroid cancer

Risk Factors Associated with Thyroid Nodules

Knowing the risk factors enables the patients to take necessary evasive actions and manage this condition better. Here are the details –

Genetic and Environmental Factors

Genetic and environmental factors play a key role in thyroid nodules: 

• Family history: A family history of thyroid disease or cancer predisposes one to the same.
• Radiation exposure: The cases of previous radiation exposure, particularly in childhood, are considered to be the main risk factors.
• Iodine intake: Prolonged deficiency and excess iodine consumption are considered to be the leading causes of nodule formation.

Patient Demographics and History

The patient’s demographic and medical history also play a part. Here is how –

• Gender: Thyroid nodule development is most common among women. 
• Medical History: Autoimmune thyroid diseases like Hashimoto’s thyroiditis make some people more vulnerable to developing nodules.

Treatment Options for TIRADS 3 Nodules

TIRADS 3 nodules require a few strategies because the overall risk of malignancy is relatively low, but there could be incremental changes with time.

Active Surveillance

Active surveillance in most of TIRADS 3 nodules has to be implemented. It involves:

• Ultrasound assessment at least once every 6 to 12 months
• Noticing changes in the size and form of the nodule or development of any other feature.

Surgical Interventions

Surgery is rarely indicated for TIRADS 3 nodules but may be considered in the following situations:

• Abnormal sizes or shapes of nodules noticed in the ultrasound
• Developing symptoms like difficulty in swallowing and other respiratory problems

Non-Surgical Treatments

Non-surgical treatments are also available for TIRADS3. Here are the details –

• Radiofrequency Ablation (RFA): Non-invasive surgery that involves the cutting out or shaving down of nodules.
• Ethanol Injection Therapy: Helps to reduce the size of the cystic nodules.

Monitoring and Follow-Up for TIRADS 3 Nodules

Monitoring and follow-up are highly important to tackle TIRADS 3 nodules. Here are the details that one must remember –

Recommended Follow-Up Intervals

First follow-up ultrasound should be done 6 months to 1 year after the initial examination.

Further assessment of this is necessary every 1–2 years, but based on the size and stability of the nodule, assessments may be performed annually or half-yearly.

Indicators for Repeat Biopsy or Intervention

Repeat FNAB or intervention may be necessary if:

• The nodule grows to more than 20% in diameter between two checkups
• Abnormal characteristics like greater vascularity appear in ultrasound
• Develops new symptoms, including a sore throat or an enlarged gland that grows rapidly

Prognosis and Long-Term Outcomes

Patients with TIRADS 3 nodules have a good prognosis in the long term. The potential risk of malignancy for TIRADS 3 nodules is low, but it is important to note every new change and consult with the doctor as required.

Having said that, early diagnosis and proper treatment help to prevent comorbidities. Those patients who undergo regular checkups have improved prognoses and diminished concerns regarding their state.

Conclusion

TIRADS 3 thyroid nodules are regarded as benign but should be managed and followed up with a lot of caution. Ultrasound examination continues to be regarded as the reference method for the evaluation of those nodules and their changes. Still, FNAB can only be applied in case of significant changes in the nodules.

Since patient management addresses individual patients' genetic risks and clinical characteristics, the treatment plan should also consider the patient’s risk profile and other factors to make it more personalised and focused for better outcomes. Regular follow-up and education is also imperative to attain a successful outcome.