Image of a markedly hypoechoic nodule. Compare the echogenicity of the nodules with that of the cervical musculature. Attention should be paid to the ultrasound parameters. The nodule pictured was solid (2 points), markedly hypoechoic (3 points), and wider-than-tall (0 points), with undefined margins (0 points) and without acoustic shadowing artifacts or echogenic foci (0 points). Therefore, the total score was 5 points and the risk level was classified as TR4.