• Karen Gabriela Bautista-Orduno, Edgar Gerardo Dorsey-Trevino, Jose Gerardo Gonzalez-Gonzalez, Dalia A Castillo-Gonzalez, Mariana Garcia-Leal, Karina Raygoza-Cortez, Michael R Gionfriddo, and Rene Rodriguez-Gutierrez.
• Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; Plataforma INVEST Medicina UANL - KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico.
• J Clin Epidemiol. 2020 Jul 1; 123: 180-188.e2.

ObjectivesThe Grading of Recommendations Assessment, Development, and Evaluations (GRADE) working group has recognized some scenarios in which strong recommendations may be supported by low-quality evidence, the so-called paradigmatic situations. The adherence to these paradigmatic situations by the American Thyroid Association (ATA) guidelines, however, remains unknown.Study Design And SettingClinical guidelines from the ATA were retrieved and deemed eligible if created using GRADE or the American College of Physicians (ACP) system. Reviewers, independently and in duplicate, assessed all strong recommendations based on low-quality evidence and judged their alignment with GRADE paradigmatic situations. The study was conducted at KER Unit Mexico.ResultsA total of five clinical guidelines, one using the GRADE and four using 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 (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]).ConclusionATA clinical guidelines are discordant with GRADE guidance. Future guidelines should carefully evaluate the quality of evidence and recognize its limitations when developing recommendations.Copyright © 2020 Elsevier Inc. All rights reserved.

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