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In Reply: We agree with Drs Shin and Lee that smoking may influence the course of Graves disease by modulating immune function. Levels of soluble IL-2 receptor, a marker of T-cell activation, have been shown to correlate positively with the activity of Graves disease, and smokers appear to have higher concentrations of soluble IL-2 receptor than nonsmokers.

However, these relationships have not been adequately studied and are likely to be more complex. In particular, it is unclear whether the association between Graves disease and circulating soluble IL-2 receptor concentration reflects the underlying autoimmune activity or, as some studies have suggested, is mediated by the hyperthyroidism. In the latter case, hyperthyroidism of any cause would elevate soluble IL-2 receptor concentration while hypothyroidism would have the opposite effect.^1-3 We agree that further research is needed to fully address these unanswered questions.

Financial Disclosures: None reported.

Moffat J. Nyirenda, MRCP
Endocrinology Unit
Queen's Medical Research Institute
University of Edinburgh
Edinburgh, United Kingdom

Geoffrey J. Beckett, PhD, FRCPath
Clinical Biochemistry
University of Edinburgh

Anthony D. Toft, MD
anthony.toft@luht.scot.nhs.uk
Endocrine Clinic
Royal Infirmary of Edinburgh
Edinburgh

1. Koukkou E, Panayiotidis P, Alevizou-Terzaki V, Thalassinos N. High levels of serum soluble interleukin-2 receptors in hyperthyroid patients: correlation with serum thyroid hormones and independence from the etiology of the hyperthyroidism. J Clin Endocrinol Metab. 1991;73(4):771-776. FREE FULL TEXT 2. Loviselli A, Calia MA, Murenu S, Mossa P, Cambosu MA, Caradonna A. Circulating soluble IL-2 receptor levels are low in patients with hypothyroid autoimmune thyroiditis. Horm Metab Res. 1994;26(11):548-551. FULL TEXT | ISI | PUBMED 3. Zwirska-Korczala K, Berdowska A, Jochem J; et al. Influence of thyroxine on serum soluble interleukin-2 receptor alpha levels in thyroid disorders. J Clin Pharm Ther. 2004;29(2):151-156. FULL TEXT | ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(19):1989.

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