Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China.
Clinical Evidence based medicine center, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China.
Endocrine. 2018 Apr;60(1):4-14. doi: 10.1007/s12020-018-1535-2. Epub 2018 Feb 14.
This study aimed to systematically evaluate the quality of guidelines for the management of hypothyroidism in pregnancy.
Systematic searches were conducted to identify hypothyroidism in pregnancy guidelines published in electronic databases and developers' websites. Four reviewers independently evaluated eligible guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Agreement among reviewers was measured using the intraclass correlation coefficient (ICC). The number of recommendations, strength of recommendations, and levels of evidence were determined. The software used for analysis was SPSS version 12.0.
Nine guidelines met the inclusion criteria and were appraised. The scope and purpose (65%) and clarity of presentation (70%) domains achieved relatively high scores, whereas the stakeholder involvement (41%), rigor of development (33%), applicability (36%), and editorial independence (31%) domains yielded low scores. The American Thyroid Association (ATA) guideline ranked the highest, whereas the 2012 Chinese Society of Endocrinology (CSE) guideline ranked the lowest among all the guidelines. The British Thyroid Association (BTA) and ATA guidelines were strongly recommended as dependable and helpful references to aid clinical decisions for medical providers, whereas the CSE guideline was not recommended. Most recommendations of the guidelines were relatively consistent. However, the nine guidelines varied with respect to their recommendations on thyroid scanning, dose of levothyroxine (L-T4) treatment, and target thyroid-stimulating hormone(TSH) level of L-T4 therapy.
The quality of the guidelines on the management of hypothyroidism in pregnancy is highly variable. Additionally, these guidelines need significant improvement, especially in the rigor of development and applicability domains. Some improvements should be made to promote the development and implementation of guidelines, for example, conducting a comprehensive search strategy to include more potential evidence and establishing a standard grading system to evaluate the quality of evidence.
本研究旨在系统评价妊娠甲状腺功能减退症管理指南的质量。
系统检索电子数据库和开发者网站上发表的妊娠甲状腺功能减退症指南。4 位评审员独立使用评估研究和评估指南 II（AGREE II）工具评估合格指南。使用组内相关系数（ICC）衡量评审员之间的一致性。确定建议数量、建议强度和证据水平。使用 SPSS 版本 12.0 进行分析。
符合纳入标准并进行评估的指南有 9 条。范围和目的（65%）以及表述清晰度（70%）领域得分较高，而利益相关者参与（41%）、制定严谨性（33%）、适用性（36%）和编辑独立性（31%）领域得分较低。ATA 指南排名最高，而 2012 年中国内分泌学会（CSE）指南在所有指南中排名最低。BTA 和 ATA 指南被强烈推荐为医疗保健提供者做出临床决策的可靠和有益的参考，而 CSE 指南则不被推荐。大多数指南的建议相对一致。然而，这 9 条指南在甲状腺扫描、左甲状腺素（L-T4）治疗剂量和 L-T4 治疗目标促甲状腺激素（TSH）水平的建议上存在差异。
妊娠甲状腺功能减退症管理指南的质量差异很大。此外，这些指南需要显著改进，特别是在制定严谨性和适用性领域。应进行一些改进以促进指南的制定和实施，例如，制定全面的检索策略以纳入更多潜在证据，并建立标准分级系统来评估证据质量。
