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The number of patients is increasing continuously, 362 patients were scanned in 2017, 1120 patients were scanned in 2018 and it is expected that until the end of this year about 2000 patients will be scanned for PET/CT imaging. The aims of the current study are: a) to estimate the incidence of second primary malignancy in patients with thyroid cancer b) the timing of occurrence in relation to thyroid cancer c) to analyze demographic, clinical characteristics and confounders of patients who were diagnosed with SPM after RAI and d) to investigate whether there is a causal association between radioiodine and the onset of second primary malignancies. Patients were categorized into 3 groups: group A included patients with thyroid cancer as the first diagnosis, group B those who were initially diagnosed with primary malignancy other than TC and group C included patients diagnosed and treated simultaneously both for thyroid cancer and other primary malignant tumors. Results: The planned course of six cycles was completed in eleven patients (37 %), was interrupted in thirteen patients (43%), while six patients (20%) were still undergoing 223Ra treatment at the time of analysis. Four patients were switched to another therapy and five out of thirteen patients died at a mean time of 8 months after cessation of 223Ra treatment due to disease progression. [Extracted from the article]