To the Editor:
We thank Dr. Shin and colleagues for their careful reading of our case report discussing a patient who developed Graves’ disease during treatment with anti-tumor necrosis factor-α (anti-TNF-α) for an active rheumatoid arthritis1. They refer to another recent report2, in which transient hyperthyroidism was observed during treatment with anti-TNF-α. Together, these observations suggest a potential link between TNF-α and Graves’ disease that remains to be elucidated.
In our opinion, current reports suggesting an association between anti- TNF-α therapy and Graves’ disease do not yet justify firm conclusions or recommendations regarding thyroid-function monitoring during treatment with anti-TNF-α. However, we agree with Shin and colleagues that further studies are warranted to investigate the role of TNF-α in Graves’ disease and subsequently the potential effect of neutralizing TNF-α on the development of Graves’ disease. When such an association has been demonstrated, monitoring thyroid function during anti-TNF-α treatment may be a necessary addition to the routine (laboratory) tests that are currently advised to prevent adverse events of anti-TNF-α treatment.
