GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context

Authors

Russell Seth Martins, Aga Khan UniversityFollow
Sarah Nadeem, Aga Khan UniversityFollow
Abeer Aziz, Aga Khan UniversityFollow
Sajjan Raja, Aga Khan UniversityFollow
Alina Pervez, Aga Khan UniversityFollow
Najmul Islam, Aga Khan UniversityFollow
Asma Ahmed, Aga Khan UniversityFollow
Aisha Sheikh, Aga Khan UniversityFollow
Saira Furqan, Aga Khan UniversityFollow
Nanik Ram, Aga Khan UniversityFollow
Azra Rizwan, Aga Khan UniversityFollow
Nashia Ali Rizvi, Aga Khan UniversityFollow
Mohsin Ali Mustafa, Aga Khan UniversityFollow
Salima Saleem Aamdani, Aga Khan UniversityFollow
Qamar Masood, Aga Khan UniversityFollow

Document Type

Article

Department

Diabetes/Endocrinology and Metabolism; Medical College Pakistan; Medicine

Abstract

Introduction: The prevalence of hyperthyroidism in Pakistan is 2.9%, which is two times higher than in the United States. Most high-quality hyperthyroidism clinical practice guidelines (CPGs) used internationally originate from high-income countries in the West. Local CPGs in Pakistan are not backed by transparent methodologies. We aimed to produce comprehensive, high-quality CPGs for the management of hyperthyroidism in Pakistan.
Methods: We employed the GRADE-ADOLOPMENT approach utilizing the 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis as the source CPG. Recommendations from the source guideline were either adopted as is, excluded, or adapted according to our local context.
Results: The source guideline included a total of 124 recommendations, out of which 71 were adopted and 49 were excluded. 4 recommendations were carried forward for adaptation via the ETD process, with modifications being made to 2 of these. The first addressed the need for liver function tests (LFTs) amongst patients experiencing symptoms of hepatotoxicity while being treated with anti-thyroid drugs (ATDs). The second pertained to thyroid status testing post-treatment by radioactive iodine (RAI) therapy for Graves' Disease (GD). Both adaptations centered around the judicious use of laboratory investigations to reduce costs of hyperthyroidism management.
Conclusion: Our newly developed hyperthyroidism CPGs for Pakistan contain two context-specific modifications that prioritize patients' finances during the course of hyperthyroidism management and to limit the overuse of laboratory testing in a resource-constrained setting. Future research must investigate the cost-effectiveness and risk-benefit ratio of these modified recommendations.

Comments

Pagination are not provided by the author/publisher.

Publication (Name of Journal)

Adolopment, Grade, Guidelines, LMIC, Pakistan, Thyroid

DOI

10.1186/s12902-023-01493-1

Recommended Citation

Martins, R. S., Nadeem, S., Aziz, A., Raja, S., Pervez, A., Islam, N., Ahmed, A., Sheikh, A., Furqan, S., Ram, N., Rizwan, A., Rizvi, N. A., Mustafa, M. A., Aamdani, S. S., Masood, Q. (2024). GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context. Adolopment, Grade, Guidelines, LMIC, Pakistan, Thyroid, 24(1).
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_diabet_endocrinol_metab/125