, Volume 60, Issue 1, pp 4–14 | Cite as

Appraisal of clinical practice guidelines on the management of hypothyroidism in pregnancy using the Appraisal of Guidelines for Research and Evaluation II instrument

  • Yuan Fang
  • Liang Yao
  • Jing Sun
  • Jian Zhang
  • Yanxia Li
  • Ruifei Yang
  • Kehu Yang
  • Limin Tian



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.


Appraisal of Guidelines for Research and Evaluation instrument Clinical practice guidelines Hypothyroidism in pregnancy Quality assessment 



The authors thank the Limin Tian and Kehu Yang for their help and support to the methodology and process.

Author contributions

Conceived and designed the experiments: Limin Tian. Performed the experiments: Yuan Fang. Analyzed the data: Jing Sun, Jian Zhang, Liang Yao, Ruifei Yang. Wrote the paper: Yuan Fang. Offered suggestions: Limin Tian, Kehu Yang, Liang Yao.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

12020_2018_1535_MOESM3_ESM.pdf (90 kb)
Supplementary Material
12020_2018_1535_MOESM4_ESM.pdf (57 kb)
Supplementary Material


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of EndocrinologyGansu Provincial HospitalLanzhouPeople’s Republic of China
  2. 2.Clinical Evidence based medicine centerGansu Provincial HospitalLanzhouPeople’s Republic of China
  3. 3.Department of Clinical MedicineNingxia Medical UniversityYinchuanPeople’s Republic of China
  4. 4.Department of UltrasonographyHebei Province Veterans HospitalBaodingPeople’s Republic of China
  5. 5.Evidence-Based Medicine CenterSchool of Basic Medical Sciences, Lanzhou UniversityLanzhouPeople’s Republic of China

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