Radioactive Iodine for Thyroid Carcinoma: An Appraisal of Practice Guidelines

Monday, October 2, 2023

4:27 PM - 4:33 PM East Coast USA Time

Location: 202A

Presenting Author(s)

Stylianos D. Monos, BA

Medical Student
Lewis Katz School of Medicine At Temple University
Merion Station, PA, United States

Co-Author(s)

CF

Christian G. Fritz, MD

Fellow
University of Pennsylvania
Philadelphia, PA, United States
DR

Dominic Romeo, MS

Student
Perelman School of Medicine, University of Pennsylvania
Philadelphia, PA, United States
JN

Jinggang Ng, MA

Perelman School of Medicine, University of Pennsylvania, USA
Jacob C. Harris, BA

Medical Student
Perelman School of Medicine
Philadelphia, PA, United States

Senior Author(s)

Karthik Rajasekaran, MD

Assistant Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
Philadelphia, Pennsylvania, United States

Co-Author(s)

AM

Alvaro G. Moreira, MD

Assistant Professor
Department of Pediatrics, University of Texas Health Science Center at San Antonio, USA

Disclosure(s):

Karthik Rajasekaran, MD: No relevant relationships to disclose.

Introduction: Radioactive iodine (RAI) therapy is the standard of care for many patients with differentiated thyroid cancer. We systematically appraise the quality of clinical practice guidelines (CPG) for the use of radioactive iodine in thyroid cancer using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

Methods: A systematic literature search was performed to identify CPGs pertaining to the indications of RAI in thyroid cancer. Data were abstracted from guidelines meeting inclusion criteria and appraised by four independent reviewers in the six domains of quality defined by the AGREE II instrument. Data was analyzed separately for guidelines assessing RAI-refractory thyroid cancer. Intraclass correlation coefficients (ICC) were calculated across domains to quantify interrater reliability.

Results: Twenty-two guidelines met inclusion criteria, of which eight pertained to RAI-refractory disease. No guideline achieved a score of >60% in five or more AGREE II quality domains, which is required to gain designation as ‘high’ quality. One “average quality” guideline authored by the British Thyroid Association respectively achieved a score of >60% in three quality domains. The remaining twenty-one CPGs demonstrated low quality content, with deficits most pronounced in domains 3, 4, 5 and 6 suggesting a lack of rigorously developed, clinically applicable, and transparent information for current guidelines.

Conclusions: As treatment for thyroid cancer moves away from a ‘one size fits all’ approach to tailored decision making that continues to include RAI, the need for high-quality guidelines becomes increasingly relevant. Few existing guidelines satisfy established appraisal criteria.