GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context.

Area of Science:

• Endocrinology
• Clinical Practice Guidelines
• Public Health

Background:

• Hyperthyroidism prevalence in Pakistan (2.9%) is double that of the US.
• International guidelines often lack local applicability and transparent methodologies.
• Need for context-specific clinical practice guidelines (CPGs) for hyperthyroidism in Pakistan.

Purpose of the Study:

• To develop comprehensive, high-quality CPGs for hyperthyroidism management tailored to Pakistan's context.
• Adapt existing international guidelines using a transparent methodology.
• Incorporate local health system needs and resource constraints.

Main Methods:

• Employed the GRADE-ADOLOPMENT approach.
• Utilized the 2016 American Thyroid Association Guidelines as the source CPG.
• Recommendations were adopted, excluded, or adapted based on local context.

Main Results:

• 124 recommendations from the source guideline were reviewed.
• 71 recommendations were adopted, 49 excluded, and 4 adapted.
• Two key adaptations: judicious use of liver function tests with anti-thyroid drugs and thyroid status testing post-radioactive iodine therapy for Graves' Disease, focusing on cost reduction.

Conclusions:

• Developed hyperthyroidism CPGs for Pakistan with two context-specific modifications.
• Modifications prioritize patient finances and limit overuse of laboratory testing in resource-constrained settings.
• Further research needed on cost-effectiveness and risk-benefit of modified recommendations.