ACR TI-RADS for Incidental Thyroid Lesions in Iraqi Patients Post Renal Transplants: A Single Center Study

Abstract

Background: Long-term immunosuppression following renal transplantation has been linked to thyroid dysfunction and malignancy. However, data on thyroid nodule prevalence and characteristics in transplant recipients remain limited. Objective: To screen in RT recipients, stratifying nodule malignancy risk using the TI-RADS reporting system. Methods: A cross-sectional study evaluated thyroid nodules in 166 clinically euthyroid renal transplant recipients attending routine follow-up at the Transplant Center, Medical City, compared with 221 age- and sex-matched healthy controls. All participants underwent standardized ultrasound using the American College of Radiology Thyroid Imaging Reporting and Data System classification. Of 39 nodules biopsied, 14 were malignant and 25 benign. Results: The mean age of RT recipients was 42±12 years, with males comprising 77.7%. Incidental thyroid nodules were identified in 42.2% compared to 31.2% in the controls. Among transplant recipients, 51.4% of nodules were solitary and 48.6% were multiple. Following TIRADS classification, TIRADS-3 was reported in 9.6% of mildly suspicious nodules, while 11.4% of the nodules were moderately suspicious TIRADS-4, and 1.8% were highly suspicious TIRADS-5. Malignancy was confirmed in 10% of biopsied nodules. TIRADS stratification demonstrated a statistically significant association with malignancy, while other demographic and clinical variables, including immunosuppressive regimen, were not predictive. The ultrasound features of nodules in the transplant group were comparable to those observed in healthy controls. Conclusions: Thyroid nodule prevalence and malignancy risk in renal transplant recipients resemble the general population; immunosuppression may not be a key factor, but ACR-TIRADS surveillance supports early selective detection.