Cystic thyroid lesions with calcifications are benign and can be reviewed regularly; if they are malignant or if there is cystic compression, surgery is needed. Cystic lesions are mostly benign, but malignant lesions with cystic changes are also possible. Calcifications can be divided into microcalcifications and macrocalcifications; in general, macrocalcifications are generally benign, while micro, needle-like sand-like calcifications should be excluded from malignant possibilities. If the cystic thyroid lesion with calcification is benign, without any accompanying clinical symptoms, it is usually sufficient to review the thyroid ultrasound regularly and observe the changes of the cyst. If the cystic thyroid lesion with calcification develops pressure symptoms such as dyspnea, dysphagia, or malignancy, thyroidectomy is usually recommended. Thyroid cystic lesions with calcification should be treated under medical supervision.