Thyroid & parathyroid

Other thyroid nonneoplastic


Topic Completed: 1 February 2015

Minor changes: 31 December 2020

Copyright: 2003-2021,, Inc.

PubMed search: calcification thyroid

Andrey Bychkov, M.D., Ph.D.
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Cite this page: Bychkov A. Calcification. website. Accessed December 2nd, 2021.
Definition / general
  • Deposition of calcium salts in thyroid gland
  • More important to radiologists than pathologists
  • Prevalence in thyroidectomy specimens is 15% (Head Neck 2002;24:651)
  • Found by ultrasound in 8% of benign (multinodular goiter) and 26% of malignant nodules (Head Neck 2002;24:651)
  • Increases with advancing age
  • Retrosternal thyroid / goiter tends to be calcified more heavily
  • Dystrophic calcification of thyroid results from degenerative changes (calcified colloid and degenerated epithelium, psammoma bodies, old hemorrhage, vessel wall, etc.)
  • Metastatic calcification is caused by elevated blood calcium / phosphate
  • Stromal calcification may progress to bone formation (Mod Pathol 2009;22:887)
  • Core needle biopsy is superior to FNA for thyroid nodules with macrocalcification (Thyroid 2015;25:657)
  • Hypercalcemia due to hyperparathyroidism, in rare cases of metastatic calcification
Radiology description
  • Microcalcifications (< 2 mm and without acoustic shadow by ultrasound) in thyroid nodules are usually psammoma bodies
  • Macrocalcifications (≥ 2 mm and with acoustic shadow) are secondary to tumor necrosis and can be seen in both benign and malignant nodules
  • Peripheral (eggshell) calcifications surrounding the nodule are secondary to chronic degenerative changes
  • Various patterns of calcification may be observed on Xray: nodular, flat, curvilinear, cloudy and a mixed type (Clin Radiol 1981;32:571)
Prognostic factors
Case reports
Clinical images

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Eggshell calcified retrosternal thyroid

Gross images

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Muddy appearance

Microscopic (histologic) images

Contributed by Andrey Bychkov, M.D., Ph.D.

Calcium oxalate
crystals (abundant)

Calcium oxalate crystals

Papillary thyroid carcinoma

PTC follicular variant with ossification

Concentric layers of calcium deposition in tumor stroma

Psammoma bodies, laminated calcifications

Evolution in psammoma body in PTC

Psammoma bodies in benign appearing thyroid

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Extensive dystrophic calcification

Osseous metaplasia with fatty marrow

Calcification induced artifact

Positive stains
Differential diagnosis
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