We read with great interest the article published by Paik et al. entitled "CT features of thyroid nodules with isolated macrocalcifications detected by ultrasonography" in Ultrasonography [1]. The authors evaluated isolated macrocalcifications (IMs) in the thyroid gland using ultrasonography (US) and computed tomography (CT). They defined IMs as isolated, calcified thyroid nodules with complete posterior acoustic shadowing in which no solid component was obviously identified within the nodules on US [1]. Their concern about IMs was that previous studies have either not clearly defined IMs [2] or categorized them incorrectly (as rim or peripheral calcifications) [3,4]. Regarding this issue, the authors clearly showed the nature of IMs on CT. Among the 20 IMs, 90% (18 of 20) showed central calcification and 10% (2 of 20) showed peripheral calcifications. Therefore, the authors argued that thyroid nodules with IMs detected on US should not be classified as rim or peripheral calcifications. The risk of malignancy of IMs seems to be 10%-20% [5]. The classification of the US lexicon plays an important role in the risk stratification of thyroid nodules for malignancy [1]. IMs are categorized as intermediate suspicion nodules in the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) [6] and as moderately suspicious nodules in the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) [7]. However, this has not been specified in the risk stratification of thyroid nodules in other thyroid society guidelines [1].