Diffuse Parenchymal Micro-calcifications in the Thyroid Gland with or without Thyroid Nodule: Clinical Significance

Document Type

Conference Proceeding

Publication Date

10-25-2024

Publication Title

Thyroid

Abstract

Introduction: Microcalcifications are sub-centimetric punctate echogenic foci without posterior acoustic shadowing seen in ultrasonography (US). They may represent dystrophic calcification, intravascular tumor thrombi calcifications, or malignant papillae infarction. Fine needle aspiration (FNA) biopsy is warranted if microcalcifications are seen in thyroid nodules, especially in solid hypoechoic nodules. Microcalcifications without nodules can be seen in up to 2% of patients with papillary thyroid cancer (PTC) and have been reported in diffuse sclerosing variant PTC and classical PTC. They are a predictor of thyroid malignancy, even without a clear nodule, and are associated with multifocality, intrathyroidal lymphatic spread, and cervical lymph node metastasis. Description of the Case: A 30-year-old female presented with diffusely enlarged thyroid and finding of snowstorm appearance on US of the thyroid. She has a family history of Graves' disease. Her TSH was 2.49 (0.45-5.33uIU/mL) and thyroid peroxidase antibody was 21 (<9IU/mL). US of the neck revealed a heterogeneous nonenlarged thyroid gland with diffuse hyperemia and numerous punctate echoes. A discrete nodule was not visualized. Several lymph nodes with punctate echoes were seen around the right thyroid lobe. CT neck showed a 1.8 x 1.1 cm heterogeneous nodule with a large dystrophic calcification in the right thyroid lobe and several abnormal-appearing right level 2 to 4 lymph nodes. FNA of the dominant right neck lymph node was positive for PTC. Thyroglobulin in the washout from the lymph node FNA was 63,843 ng/mL. She underwent total thyroidectomy with central and right lateral neck dissection. Pathology revealed 1.8 cm conventional type PTC in the right thyroid lobe, papillary thyroid microcarcinomas diffusely involving both thyroid lobes (greater than 20 foci), all welldifferentiated with papillary and follicular growth patterns, and 26 out of 74 regional lymph nodes with PTC (largest 1.8 cm). Chronic lymphocytic thyroiditis was also seen. Discussion: Diffuse microcalcifications in the thyroid gland, even without a clearly delineated thyroid nodule is an indicator of thyroid malignancy and can predict cervical lymph node metastasis. Current guidelines do not specifically address how to manage this sonographic finding. Further evaluation to assess cervical lymph nodes is warranted if diffuse parenchymal microcalcifications are seen on ultrasound.

Volume

34

First Page

A25

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