FRI515 GRADE-Adolopment Of Hyperthyroidism Treatment Guidelines For A Pakistani Context
Authors: Pervez Alina , Seth Martins Russell , Aziz Abeer , Raja Sajjan , Islam Najmul , Ahmed Asma , Sheikh Aisha , Furqan Saira , Ram Nanik , Rizwan Azra , Ali Rizvi Nashia , Ali Mustafa Mohsin , Saleem Aamdani Salima , Ayub Bushra , Qamar Masood Muhammad , Haider Adil H , Nadeem Sarah 
Published: October 2023

Abstract
Disclosure: A. Pervez: None. R. Martins: None. A. Aziz: None. S. Raja: None. N. Islam: None. A. Ahmed: None. A. Sheikh: None. S. Furqan: None. N. Ram: None. A. Rizwan: None. N. Rizvi: None. M. Mustafa: None. S. Aamdani: None. B. Ayub: None. M.Q. Masood: None. A. Haider: None. S. Nadeem: None.
Background: Hyperthyroidism is a common endocrinological disorder in Pakistan. The prevalence of hyperthyroidism here is four times higher than the United States. Most high-quality hyperthyroidism clinical practice guidelines (CPGs) originate from high-income countries. Due to resource constraints, de novo local guideline creation is restricted in lower-middle income countries which adopt internationally created CPGs lacking a local context. Thus, we aimed to produce a comprehensive evidence-based CPG for the management of adult outpatient hyperthyroidism patients in Pakistan. Methods: An adaptation of the GRADE-ADOLOPMENT process was followed in collaboration with the GRADE working group. Adolopment describes a combination of adoption (verbatim use), adaptation (contextual modifications), and de novo development, thus leveraging the benefits of pre-existing high-quality CPGs while ensuring local appropriateness. The 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis was selected as the source CPG by a panel of local endocrinology experts. Recommendations from the source CPG were either adopted, excluded, or adapted. Adaptation was done using the evidence-to-decision framework. Results: The source CPG included a total of 124 recommendations, of which 71 were adopted as is. 49 recommendations were excluded due to reasons including but not limited to unavailability of drugs, inapplicability to the existing health-care system of Pakistan or different target audience. 4 recommendations were carried forward for adaptation, 2 of these remained unchanged after collection of local contextual data and consensus between the local endocrinologists. 2 recommendations were modified from the source CPG. The first recommended using ALT only instead of a full liver function test amongst patients experiencing symptoms of hepatotoxicity while being treated with anti-thyroid drugs. The second pertained to thyroid status testing post-treatment by radioactive iodine therapy for Graves’ Disease with only FT4 instead of a full thyroid profile. Both adaptations centered around the judicious use of laboratory investigations to reduce costs of hyperthyroidism management. Conclusion: Our CPG for the management of hyperthyroidism in Pakistan consists of 75 recommendations, of which two recommendations have context-specific adaptations that prioritize patients’ finances during hyperthyroidism management and limit the overuse of laboratory testing in a resource-constrained setting. Our revised methodology is a resource-efficient method for developing CPGs with a local context. We aim to publish and disseminate this CPG to improve hyperthyroidism care provision in Pakistan. Future research must investigate the cost-effectiveness and risk-benefit ratio of these modified recommendations.
Presentation: Friday, June 16, 2023