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Abstract：
BACKGROUND: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：巴基斯坦甲状腺功能亢进症的患病率为2.9％，是美国的两倍。国际上使用的大多数高质量的甲状腺功能亢进临床实践指南（CPG）都来自西方高收入国家。巴基斯坦的地方CPG没有透明的方法支持。我们的目标是生产全面的，巴基斯坦甲状腺功能亢进管理的高质量CPG。
方法：我们采用GRADE-ADOLOPMENT方法，利用2016年美国甲状腺协会甲状腺功能亢进症和甲状腺毒症其他原因的诊断和管理指南作为来源CPG。来源指南的建议要么被原样采纳，排除，或者根据我们当地的情况改编。
结果：来源指南共包括124条建议，其中71人被采纳，49人被排除在外。通过ETD过程提出了4项适应建议，对其中的2个进行了修改。第一个解决了在使用抗甲状腺药物（ATD）治疗时出现肝毒性症状的患者对肝功能测试（LFTs）的需求。第二个与放射性碘(RAI)治疗Graves病(GD)后甲状腺状态检测有关。两种适应方法都围绕着合理使用实验室检查以降低甲状腺功能亢进管理的成本。
结论：我们为巴基斯坦新开发的甲状腺功能亢进症CPG包含两个特定环境的修改，在甲状腺功能亢进症管理过程中优先考虑患者的财务状况，并限制在资源有限的环境中过度使用实验室检测。未来的研究必须调查这些修改后的建议的成本效益和风险效益比。
方法：我们采用GRADE-ADOLOPMENT方法，利用2016年美国甲状腺协会甲状腺功能亢进症和甲状腺毒症其他原因的诊断和管理指南作为来源CPG。来源指南的建议要么被原样采纳，排除，或者根据我们当地的情况改编。
结果：来源指南共包括124条建议，其中71人被采纳，49人被排除在外。通过ETD过程提出了4项适应建议，对其中的2个进行了修改。第一个解决了在使用抗甲状腺药物（ATD）治疗时出现肝毒性症状的患者对肝功能测试（LFTs）的需求。第二个与放射性碘(RAI)治疗Graves病(GD)后甲状腺状态检测有关。两种适应方法都围绕着合理使用实验室检查以降低甲状腺功能亢进管理的成本。
结论：我们为巴基斯坦新开发的甲状腺功能亢进症CPG包含两个特定环境的修改，在甲状腺功能亢进症管理过程中优先考虑患者的财务状况，并限制在资源有限的环境中过度使用实验室检测。未来的研究必须调查这些修改后的建议的成本效益和风险效益比。
