Scoring is determined by five categories. The higher the cumulative score, the higher the TR and the higher the likelihood of malignancy. One score is assigned from each of the following categories.

Margin (choose one)

• smooth: 0 points
• ill-defined: 0 points
• lobulated/irregular: 2 points
• extra-thyroidal extension: 3 points

Composition (choose one)

• cystic or completely cystic: 0 points
• spongiform: 0 points
• mixed cystic and solid: 1 point
• solid or almost completely solid: 2 points

Echogenicity (choose one)

• anechoic: 0 points
• hyper- or isoechoic: 1 point
• hypoechoic: 2 points
• markedly hypoechoic: 3 points

Shape (choose one)

• wider than tall: 0 points
• taller than wide: 3 points

Echogenic foci (choose one or more)

• none: 0 points
• comet-tail artifact: 0 points
• macrocalcifications: 1 point
• peripheral/rim calcifications: 2 points
• microcalcification: 3 points

• TR1: 0 points (benign)
• TR2: 2 points (not suspicious)
• TR3: 3 points (mildly suspicious)
• TR4: 4–6 points (moderately suspicious)
• TR5: ≥7 points (highly suspicious)