2025 Medical Science Popularization - Thyroid Nodule Grading/Classification and Treatment Guide

At present, ultrasound is the preferred imaging examination method for evaluating thyroid nodules. It can clarify the number, size, shape, boundaries, internal structure and blood supply of nodules, thereby determining the benign or malignant nature of the nodules and guiding clinical treatment strategies.

C-TIRADS, the Chinese Ultrasound Malignancy Risk Stratification Guidelines for Thyroid Nodules, takes into account a variety of ultrasound features, including but not limited to the location, orientation, margin, boundary, morphology, structure, echo texture, etc. of the nodules. Now I will introduce you to C-TIRADS:

C-TIRADS Category 1

No nodules, no score, and the malignancy rate is 0%.

Usually no further treatment is required, but re-examination is necessary.

C-TIRADS Category 2

The nodule score was -1 and the malignancy rate was 0%.

Usually no further treatment is required, and follow-up observation is sufficient.

C-TIRADS Category 3

A score of 0 means the malignancy rate is less than 2%.

It is generally benign, but if the nodule is large or has compressive symptoms, a puncture biopsy may be considered.

C-TIRADS category 4a

A score of 1 indicates a malignancy rate of 2% to 10%.

Ultrasound-guided fine needle aspiration (FNA) is recommended.

C-TIRADS category 4b

The score is 2, and the malignancy rate is 10%~50%.

It is recommended to actively perform ultrasound-guided FNA and choose appropriate surgical treatment according to the specific situation.

C-TIRADS category 4c

The score is 3~4, and the malignancy rate is 50%~90%.

It is recommended to actively perform ultrasound-guided FNA and choose appropriate surgical treatment according to the specific situation.

C-TIRADS Category 5

A score of 5 indicates a malignancy rate greater than 90%.

It is recommended to actively perform ultrasound-guided FNA and choose appropriate surgical treatment according to the specific situation.

C-TIRADS Category 6

For nodules that have been confirmed to be malignant by FNA, appropriate treatment options should be selected based on the specific circumstances.

The mortality rate of thyroid cancer is low. According to relevant statistics, it is only (0.2~0.3)/100,000 in developed countries. Most papillary thyroid microcarcinomas (PTMC) have mild biological behaviors, and patients may not show any clinical symptoms throughout their lives. Therefore, more and more opinions support the use of active monitoring strategies for low-risk PTMCs rather than traditional surgical resection.

In view of the above characteristics of thyroid cancer, and the different needs, ideas, and practices of each person, I often tell patients that no matter whether you choose follow-up observation or surgery, please accept it happily and firmly believe that your choice is the best, because no one knows what the result will be if you take another path. When you can happily accept your choice and face it positively, you have already defeated the disease itself. At the same time, regular work and rest, balanced nutrition, moderate exercise, and a happy mood are always the simplest, most affordable and effective ways to prevent and defeat the disease.