title: Rebound thymic hyperplasia detected by 18F-FDG PET/CT after radioactive iodine ablation therapy for thyroid cancer.
abstract: BACKGROUND
  Rebound thymic hyperplasia (RTHP) is not an uncommon finding after radiation or chemotherapy in patients with various malignancies. However, there are limited case reports of this phenomenon after radioactive iodine ablation therapy (RIAT) in differentiated thyroid cancer (DTC). The goal of this study was to evaluate the incidence, patterns, and factors affecting RTHP after RIAT using (18)F-FDG PET/CT.
  
  
  METHODS
  The study design was a retrospective review of 2550 patients (568 men, 1982 women; age 13-79 years) who underwent FDG PET/CT imaging after total thyroidectomy and RIAT from June 2009 through June 2012. Patients were divided into four age-related subgroups. Overall incidence, age-related incidences, and sex distribution were evaluated in patients with thymic FDG uptake on PET/CT (RTHP+). The correlation between incidence of RTHP and age was assessed using the Cochran-Armitage trend test. The Wilcoxon rank-sum test and multiple regression were applied to investigate the effect of applied dose of radioactive iodine (RAI) and age on the incidence of RTHP. Correlations of standardized uptake value (SUV) and thymic volume with age and morphologic type were also evaluated.
  
  
  RESULTS
  Overall incidence of RTHP after RIAT was 1.49%, and all of the RTHP+ patients except one were female. The Cochran-Armitage trend test revealed significantly decreased incidence from the second to fifth decade (8.84%, 1.74%, 0.98%, and 0.39% respectively; p<0.001). In each age-related subgroup, the RAI dose was significantly higher in the RTHP+ than RTHP- group (p<0.001), while there was no difference in RAI dose in RTHP+ patients among age-related subgroups (p=0.838). SUVmean and SUVmax of RTHP revealed no meaningful correlation with RAI dose or age. There were no differences among morphologic patterns of RTHP in age distribution and ablation dose.
  
  
  CONCLUSIONS
  RTHP after RIAT showed a strong female predominance, despite the higher administration dose of RAI in male patients. Although the decreased incidence of RTHP after RIAT with age is similar to the pattern of RTHP induced by other causes, the fact that older patients, even sixth decade patients, can present with RTHP after RIAT is noteworthy in the management of DTC.
authors: 1 Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul, Korea.
authors: Tae Joo
authors: TJ
authors: Jeon
authors: Yong Sang
authors: YS
authors: Lee
authors: Jae-Hoon
authors: JH
authors: Lee
authors: Hang Seok
authors: HS
authors: Chang
authors: Young Hoon
authors: YH
authors: Ryu
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D012189:Retrospective Studies; D013952:Thymus Hyperplasia / Q000000981:diagnostic imaging* / Q000209:etiology; D013964:Thyroid Neoplasms / Q000532:radiotherapy*; D014055:Tomography, Emission-Computed; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes; D019788:Fluorodeoxyglucose F18