Modified K-TIRADS 4B nodule with solid hypoechoic US pattern in a 76-year-old man.Transverse US shows a solid mildly hypoechoic nodule (11 mm) with macrocalcification and no suspicious features in the right thyroid lobe. This nodule is classified as intermediate-risk by the AACE/ACE/AME guideline, moderately suspicious (TR4) by the ACR TI-RADS, intermediate suspicion by the ATA guideline, intermediate-risk (TIRADS 4) by the EU-TIRADS, and intermediate suspicion (TIRADS 4) by the K-TIRADS. Final diagnosis: papillary thyroid carcinoma by surgery. K-TIRADS, Korean Thyroid Imaging Reporting and Data System; US, ultrasonography; AACE, American Association of Clinical Endocrinologists; ACE, American College of Endocrinology; AME, Associazione Medici Endocrinologi; ACR TI-RADS, American College of Radiology Thyroid Imaging Reporting and Data System; ATA, American Thyroid Association; EU-TIRADS, European Thyroid Imaging Reporting and Data System.