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Understanding Calcified Thyroid Nodules

What are calcified thyroid nodules, and how are they diagnosed and treated?
Understanding Calcified Thyroid Nodules
Last updated:
6/29/2023
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Calcified thyroid nodules are common in the general population, with estimates suggesting that up to 60% of adults over 60 may have them. While most calcified nodules are benign and pose no immediate health threat, their presence can indicate underlying thyroid dysfunction and may be a sign of thyroid cancer in rare cases. Ahead, a look at how calcified thyroid nodules are diagnosed and treated.

About the thyroid gland and thyroid nodules

The thyroid gland is a small, butterfly-shaped gland in the neck, just below the Adam’s apple. Despite its small size, it plays a critical role in regulating the body’s metabolism, growth, and development.

The thyroid gland has millions of tiny follicles that produce and store two essential hormones: thyroxine (T4) and triiodothyronine (T3).

In some cases, abnormal growths called thyroid nodules form in the thyroid gland. While most nodules are benign, some may be cancerous. Diagnostic thyroid testing and imaging studies can identify several types of thyroid nodules.

Solid nodules are the most common type of thyroid nodule and are typically benign. They are composed of thyroid tissue and feel firm when touched. Cystic nodules are fluid-filled and may be either benign or malignant. They may produce no symptoms or cause swelling and discomfort.

Papillary thyroid carcinoma is a common type of thyroid cancer that accounts for over 70% of all thyroid cancer cases. Papillary thyroid carcinomas typically appear as a single nodule on one side of the thyroid gland but can also occur in multiple nodules. They often have a calcified center and may have irregular borders.

Follicular thyroid carcinoma accounts for approximately 10% of all thyroid cancer cases. This type of cancer typically arises in a single thyroid nodule and spreads to the nearby tissue and blood vessels. It may also have a calcified center and irregular borders.

Anaplastic thyroid carcinoma is a rare but aggressive form of thyroid cancer that accounts for less than 5% of all thyroid cancer cases. Anaplastic thyroid carcinomas typically arise from a pre-existing nodule and rapidly grow and spread to the surrounding tissue and lymph nodes.

What is calcification?

Calcification is a process in which calcium builds up in body tissue, causing it to harden. Calcification is not due to dietary calcium intake. Instead, several factors can contribute to calcification, including:

  • Elevated calcium blood level (hypercalcemia): This can occur due to a variety of factors, such as an overactive parathyroid gland or certain types of cancer
  • Tissue injury: Inflammation or damage to tissues can cause the body to release proteins that bind calcium in clumps, leading to calcification
  • Aging: As we age, our bodies become less efficient at processing and removing excess calcium, which can lead to calcification
  • Certain medical treatments: Past surgeries or cancer treatments can increase the risk of calcification.

Calcification can occur in almost any body part, including soft tissues, arteries, organs, and glands, including the thyroid.

What are calcified thyroid nodules?

Calcified thyroid nodules are a common finding in patients with thyroid nodules. These nodules are defined as growths or masses that form within the thyroid gland, which is responsible for producing hormones that regulate metabolism and growth.

A calcified thyroid nodule is a type of thyroid nodule that has become hardened or calcified due to the accumulation of calcium and other minerals. This can occur for various reasons, such as injury, inflammation, or aging.

While most calcified thyroid nodules are benign, monitoring their growth and characteristics is essential. In some cases, they may become malignant and develop into thyroid cancer.

There are different patterns of calcification in thyroid nodules. Peripheral calcifications are commonly found in papillary thyroid cancer, while coarse calcification is more common in benign nodules. Fine-needle aspiration biopsy is often used to evaluate thyroid nodules and can help determine if a calcified nodule is benign or malignant.

Management of thyroid nodules may involve surgical removal, monitoring growth and characteristics through ultrasound imaging, or biopsy. The American Thyroid Association recommends considering biopsy for nodules with macrocalcification, suspicious sonographic features, and solid components.

Causes of calcified thyroid nodules

The exact cause of calcification within thyroid nodules is still not entirely understood, but there are a few theories. Some researchers believe that calcification results from aging, particularly in nodules that have been present for a long time. Others think it could be due to inflammation within the nodule, which can lead to the accumulation of calcium over time.

The calcification may sometimes be a sign of underlying thyroid disease. For example, patients with Hashimoto’s thyroiditis, an autoimmune disorder that causes thyroid gland inflammation, have a higher risk of developing calcified nodules. Similarly, patients with multinodular goiters may have calcified nodules due to the growth and enlargement of multiple nodules within the thyroid gland.

While calcification within a thyroid nodule can be concerning, it is important to remember that most calcified nodules are benign. However, more aggressive management may be required in some instances, such as nodules with suspicious sonographic features or those with small amounts of calcification. To properly evaluate and manage thyroid nodules, it is essential to consult a healthcare provider specializing in evaluating these conditions, such as an endocrinologist

Risk factors for calcified thyroid nodules

While calcified thyroid nodules are often benign and pose no immediate health threat, certain risk factors can increase the likelihood of developing these nodules.

One of the foremost risk factors for developing calcified thyroid nodules is age. This is because the thyroid gland can develop nodules that become calcified over time as the body ages. 

Another risk factor for developing calcified thyroid nodules is a history of radiation exposure. Radiation therapy, especially to the head and neck region, has been linked to an increased risk of developing thyroid nodules, including those that are calcified.

Besides a history of Hashimoto’s, other risk factors for developing calcified thyroid nodules include a family history of thyroid nodules or thyroid cancer and certain lifestyle factors such as smoking and poor dietary habits.

It is important to note, however, that not all thyroid nodules will become calcified, and the majority of calcified nodules are benign. Nonetheless, patients with risk factors for developing calcified thyroid nodules or other thyroid disorders should be monitored closely by a healthcare provider and undergo regular thyroid function tests and imaging studies to detect any changes in the thyroid gland.

Role of genetics and the environment

Research has shown that a combination of genetic and environmental factors can play a role in the development of calcified thyroid nodules.

Studies have identified several genes involved in regulating the growth and function of the thyroid gland, as well as genes associated with an increased risk of developing thyroid cancer. For instance, mutations in the BRAF gene are particularly prevalent in papillary thyroid carcinoma, the most common type of thyroid cancer. Mutations in the RET gene have been associated with medullary thyroid cancer.

While genetic factors are undoubtedly important in determining a person’s risk of developing calcified thyroid nodules, they do not tell the whole story. Other factors, such as environmental exposure, lifestyle choices, and hormonal imbalances, can also increase the risk of nodules forming.

The environment in which a person lives can have a significant impact on their thyroid health. Exposure to radiation from medical treatments or environmental sources has long been recognized as a risk factor for developing thyroid nodules and cancer. Certain chemicals, such as perchlorate and polychlorinated biphenyls (PCBs) found in some foods and household products, may also disrupt thyroid function and increase the risk of developing nodules.

Lifestyle factors like smoking, poor diet, and lack of exercise have also been linked to an increased risk of developing thyroid nodules. Smoking, for instance, has been shown to increase the risk of nodules with macrocalcification, while a diet that is low in iodine can lead to the development of multinodular goiters.

Symptoms of calcified thyroid nodules

The majority of patients with calcified thyroid nodules do not experience any symptoms. In fact, many nodules are discovered during routine medical examinations or imaging scans for unrelated conditions. However, in some cases, calcified thyroid nodules can cause symptoms such as neck swelling or discomfort, difficulty swallowing or breathing, and changes in voice quality. These symptoms occur when the thyroid gland is enlarged and presses on nearby structures, such as the trachea or esophagus.

Another symptom that may be present in patients with calcified thyroid nodules is difficulty regulating body temperature. Patients may experience hot flashes, excessive sweating, or a feeling of coldness, even in warmer temperatures.

It is important to note that these symptoms can also indicate other thyroid conditions, such as multinodular goiters or thyroid cancer. Therefore, it is vital to seek medical attention if you experience any of these symptoms.

In addition, if you have a history of thyroid disease or have been exposed to environmental factors that can increase your risk for thyroid problems, such as radiation, it is important to undergo regular in-person thyroid screenings with an endocrinologist. This will help detect any abnormalities early on and allow for prompt treatment.

If a calcified thyroid nodule is suspected, your doctor may recommend further diagnostic tests, such as a fine-needle aspiration biopsy or imaging studies, to determine if the nodule is cancerous or benign.

How are calcified thyroid nodules diagnosed?

During a physical examination, your doctor will feel your neck to check for any lumps or irregularities. If a nodule is found, your doctor may order imaging tests to get a better look at the nodule and its surrounding tissues. The most common imaging tests used to diagnose calcified thyroid nodules are ultrasound and computed tomography (CT) scans.

Ultrasound uses high-frequency sound waves to create images of the thyroid gland and surrounding tissues. CT scans use X-rays to generate detailed images of the thyroid gland and other internal structures. These imaging tests can help determine the nodule’s size, location, and characteristics, such as solid or fluid-filled.

If the imaging tests indicate the presence of a thyroid nodule, your doctor may recommend a fine-needle aspiration biopsy. This procedure involves inserting a thin needle into the nodule to remove a small tissue sample which is then examined under a microscope to determine if the nodule is benign or malignant.

Sometimes, a biopsy may not be possible or inconclusive, and your doctor may recommend additional tests. These tests may include a molecular or genetic test, which analyzes the DNA of the thyroid cells, or a radioactive iodine scan, which is used to determine how active the thyroid is.

How are calcified thyroid nodules treated?

The treatment for calcified thyroid nodules depends on the underlying cause. No treatment is usually necessary for benign nodules that do not affect swallowing or breathing as they typically remain stable.

Radiofrequency ablation (RFA) may be recommended for larger or more invasive nodules. RFA is a non-surgical treatment performed by inserting a needle-like probe into the thyroid nodule. The needle tip heats up and destroys the nodule from the inside, causing it to shrink.

In other cases, calcified thyroid nodules may be treated with thyroid medications to stabilize hormone levels. Other drugs, such as antibiotics, may also be prescribed if there is a bacterial infection in the nodule. If the calcified thyroid nodule is causing pain or pressure, your doctor may recommend over-the-counter pain relievers or prescription medications to help relieve these symptoms.

If the nodules are cancerous, surgery is usually recommended to remove them. In some cases, radioactive iodine therapy may also be used to shrink or destroy the tumor.

A note from Paloma

Calcified thyroid nodules are usually not serious and do not usually require treatment. However, if your doctor suspects that the nodule might be cancerous or it’s causing symptoms such as pain or pressure, further testing and treatment are essential.

While Paloma Health specialists do not provide diagnosis and treatment for nodules or thyroid cander, Paloma is a great option for patients with hypothyroidism and benign thyroid nodules looking for high-quality care. The Paloma team of experienced thyroid doctors offers an integrative approach to diagnosis and treatment, working to find the right treatment for each patient. By taking a brief quiz, you can be matched with a Paloma doctor who can provide personalized, convenient, and affordable thyroid care. Schedule an appointment with a Paloma doctor today to get started.

References:

Haugen BR, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020. PMID: 26462967; PMCID: PMC4739132. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739132/

Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee. American Journal of Roentgenology. 2019;213(6):W1-W14. https://pubmed.ncbi.nlm.nih.gov/26419308/

Zhang Y, Liang J, Liang J, et al. Diagnostic performance of simplified TI-RADS for malignant thyroid nodules: comparison with 2017 ACR-TI-RADS and 2020 C-TI-RADS. Cancer Imaging. 2022;22(1):41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740871/

Grant EG, Tessler FN, Hoang JK, et al. Thyroid Imaging Reporting and Data System (TI-RADS): a user’s guide. Radiology. 2018;287(1):185-193. https://pubmed.ncbi.nlm.nih.gov/29558300/

Horvath E, Majlis S, Rossi R, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009;94(5):1748-1751. https://pubmed.ncbi.nlm.nih.gov/19276237/c

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Neeyaz Zolfaghari

Holistic Nutritionist and Nourishment Coach

Neeyaz is a Holistic Nutritionist and Nourishment Coach. Her philosophy is built around nurturing your inner home, to transform your outer home. After learning how to heal from an autoimmune thyroid disease, Neeyaz was inspired and moved by her own journey and chose to take this self love into a business built around supporting others throughout their healing journey. Find her online at www.unspokennutrition.com.

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