A thyroid ultrasound report is full of medical terms that can feel overwhelming. This guide walks through the most common sections and terms, translating each one into plain language so you can understand your results and have an informed conversation with your doctor.
What the Report Covers
A standard thyroid ultrasound report describes the overall size of the thyroid gland, the appearance of each lobe, and any nodules found. For each nodule, it typically reports the size, location, and ultrasound features that determine its TI-RADS category.
Thyroid Size and Volume
The report lists three measurements for each lobe: length, width, and depth in centimeters. These are used to calculate the volume of each lobe and the total thyroid volume. Normal adult total volume is roughly 10 to 18 mL depending on gender. You can check your own with the thyroid volume calculator.
Echogenicity
Echogenicity describes how bright or dark the thyroid tissue or a nodule appears. The report may say isoechoic (same brightness as normal thyroid), hyperechoic (brighter), hypoechoic (darker), very hypoechoic (very dark), or anechoic (black, fluid-filled). Darker nodules carry slightly more concern. See our detailed hypoechoic guide for more.
Composition
Composition tells you what the nodule is made of. Terms you may see include cystic (fluid-filled), solid (tissue throughout), mixed (both fluid and solid), or spongiform (many tiny fluid pockets). Solid nodules score higher than cystic ones in TI-RADS because cancers are almost always solid.
Shape and Margin
Shape refers to whether the nodule is wider-than-tall (normal, 0 points) or taller-than-wide (concerning, 3 points). Margin describes the edges: smooth (reassuring), ill-defined, lobulated, irregular (concerning), or showing extra-thyroidal extension (most concerning).
Echogenic Foci
These are bright spots inside the nodule. The report may mention macrocalcifications (large calcium deposits), peripheral calcifications (ring-shaped), punctate echogenic foci (tiny bright dots suggesting microcalcifications), or comet-tail artifacts (benign). Punctate foci carry the highest concern.
The TI-RADS Category
Many reports now include a TI-RADS category for each nodule, ranging from TR1 (benign) to TR5 (highly suspicious). This category is based on the features described above. If your report does not include a TI-RADS category, you can determine it yourself by entering the described features into the TI-RADS calculator.
For what each category means, see our TI-RADS score guide.
The Recommendation
The report usually ends with a recommendation based on the TI-RADS category and nodule size: no follow-up needed, follow-up ultrasound in a specified timeframe, or fine needle aspiration biopsy. This recommendation follows the size thresholds shown on the TI-RADS chart.
What to Do Next
Read the recommendation at the bottom of your report. If it says follow-up or biopsy, schedule it. If it says no further workup, that is genuinely good news. If anything is unclear, bring the report to your next appointment and ask your doctor to walk through it with you.
Frequently Asked Questions
My report does not have a TI-RADS score. Is that a problem?
Not all facilities use TI-RADS in their reports. You can determine the category yourself using the features listed in the report and the TI-RADS calculator.
What does “heterogeneous thyroid” mean?
It means the thyroid tissue has an uneven texture rather than a smooth, uniform appearance. This is common in Hashimoto thyroiditis and is a finding about the gland itself, not about a specific nodule.
Should I get a second opinion on my ultrasound?
If your report recommends biopsy or if you have concerns about the interpretation, requesting a second radiologist’s review is reasonable and common. Many academic centers offer thyroid ultrasound second opinions.