LAUSR

OBJECTIVE The GRADE working group has recognized some scenarios in which strong recommendations may be supported by low-quality of evidence, the so-called paradigmatic situations. The adherence to these paradigmatic situations by the American Thyroid Association (ATA) guidelines, however, remains unknown STUDY DESIGN: Clinical guidelines from the ATA were retrieved and deemed eligible if created utilizing GRADE or the ACP system. Reviewers, independently and in duplicate, assessed all strong recommendations based on low-quality evidence and judged their alignment with GRADE paradigmatic situations. SETTING KER Unit Mexico RESULTS: A total of 5 clinical guidelines, 1 using the GRADE and 4 the ACP system, were eligible for analysis. We assessed a total of 518 recommendations, of which 355 (69%) were labeled as "strong" and 163 (31%) as "weak". A total of 151 strong recommendations were based on low-quality evidence, of which 36 (24%) were congruent with one of the five GRADE paradigmatic situations, whereas 115/151 (76%) were not consistent with any paradigmatic situations and should have been categorized as weak (23% [26/115]) or best-practice recommendations (77% [89/115]). CONCLUSIONS ATA clinical guidelines are discordant with GRADE guidance. Future guidelines should carefully evaluate the quality of evidence and recognize its limitations when developing recommendations.