Risk of malignancy in thyroid nodules classified as TIR-3A: What therapy?

•Thyroid nodules with TIR3A cytology have a lower risk of malignancy than TIR3B cases.•The new SIAPEC classification has proved accurate and effective.•Malignancy rates in nodules with TIR3A cytology are higher than expected.•The accurate definition of the risk of TIR3A nodules is extremely difficult.•A careful assessment of risk factors and ultrasound characteristics is always needed.