From: GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context
Original Recommendation | Liver function and hepatocellular integrity should be assessed in patients taking MMI or PTU who experience pruritic rash, jaundice, light-colored stool or dark urine, joint pain, abdominal pain or bloating, anorexia, nausea, or fatigue (Strong Recommendation; Low Quality Evidence). | |||
Modified Recommendation | Liver function tests and hepatocellular integrity should be assessed in patients taking MMI or PTU who experience specific symptoms (pruritic rash, jaundice, light-colored stool or dark urine, abdominal pain) or multiple non-specific symptoms (joint pain, bloating, anorexia, nausea, or fatigue) using only ALT instead of a full LFT panel (alanine transaminase, aspartate transaminase, alkaline phosphatase, gamma-glutamyl transferase; total, conjugated and unconjugated bilirubin) routinely (Strong Recommendation; Low Quality Evidence). | |||
Overall Conclusion | ||||
☒Strong recommendation for Modified Recommendation | ☐Conditional recommendation for Modified Recommendation | ☐Conditional recommendation for either Original Recommendation or Modified Recommendation | ☐Conditional recommendation for Original Recommendation | ☐Strong recommendation for Original Recommendation |
Additional Suggestions: • Remain wary that checking ALT only may lead to missed diagnosis of cholestasis. • In patients with prior history of liver disease or high suspicion of liver damage (multiple specific symptoms), then baseline full LFTs should be performed. • Following drug withdrawal, LFTs need to be repeated after 1–2 weeks | ||||
Justification: • The magnitude of liver dysfunction with ATDs in clinical practice is limited, usually occurring with intercurrent illness. |