Assessment of the Scandinavian guidelines on papillary thyroid cancer using the AGREE II instrument

Clinical practice guidelines are intended to help with decision-making. However, their quality differs. Guidelines of low quality are a waste of resources and can cause patient harm. We compared the quality of the Danish, Norwegian, and Swedish guidelines on papillary thyroid cancer (PTC) with those of the American Thyroid Association (ATA, 2015 version).

Three pairs of appraisers independently rated the guidelines using the AGREE II instrument, a validated tool for assessing the quality of guidelines. Furthermore, recommendations on the extent of surgery in low-risk PTC, prophylactic lymph node dissection, thyroxine suppression, radioiodine treatment, active surveillance, and the length of follow-up after treatment, along with the evidence cited to support these recommendations, were compared across the four guidelines.

Overall, the ATA guidelines had the highest quality, with a score of over 70 % in four domains, and the highest score in five of six domains. The Danish and Swedish guidelines each reached a score of over 70 % in only one domain, while the Norwegian guidelines did not reach that score in any domain. The overall score was 83 % for the ATA guidelines, 50 % for the Danish, 44 % for the Swedish, and 28 % for the Norwegian. Recommendations varied widely, particularly regarding extent of surgery and indications for radioiodine treatment. The ATA guidelines had the highest number of references supporting the recommendations.

The quality of clinical practice guidelines and recommendations on treatment for PTC differed between the Scandinavian countries and the ATA, with the ATA having the highest quality.