Thryoid Storm Diagnosis

Aka: Thryoid Storm Diagnosis, Burch Wartofsky Score

1. See Also
   1. Hyperthyroidism
   2. Thyroid Storm
2. Indications
   1. Hyperthyroidism with suspected Thyroid Storm
3. Criteria
   1. Thermoregulatory dysfunction
      1. Score 5: Temp 99 to 99.9 F
      2. Score 10: Temp 100 to 100.9 F
      3. Score 15: Temp 101 to 101.9 F
      4. Score 20: Temp 102 to 102.9 F
      5. Score 25: Temp 103 to 103.9 F
      6. Score 30: Temp >104 F
   2. Central Nervous System Effects
      1. Score 0: Absent
      2. Score 10: Mild (e.g. Agitation)
      3. Score 20: Moderate (e.g. Delirium, Psychosis, severe lethargy)
      4. Score 30: Severe (e.g. Seizure, coma)
   3. Gastrointestinal-Hepatic Dysfunction
      1. Score 0: Absent
      2. Score 10: Moderate (e.g. Diarrhea, Nausea or Vomiting, Abdominal Pain)
      3. Score 20: Severe (e.g. unexplained Jaundice)
   4. Cardiovascular Dysfunction
      1. Score 5: Pulse 90 to 109
      2. Score 10: Pulse 110 to 119
      3. Score 15: Pulse 120 to 129
      4. Score 20: Pulse 130 to 139
      5. Score 25: Pulse >140
   5. Congestive Heart Failure Dysfunction
      1. Score 0: Absent
      2. Score 10: Mild (e.g. pedal edema)
      3. Score 20: Moderate (e.g. bibasilar rales)
      4. Score 30: Severe (e.g. Pulmonary Edema)
   6. Atrial Fibrillation
      1. Score 0: Absent
      2. Score 10: Present
   7. Precipitant History
      1. Score 0: Absent
      2. Score 10: Present
4. Interpretation
   1. Score 45+: Thyroid Storm
   2. Score 25 to 44: Impending Thyroid Storm
   3. Score <25: Unlikely to be Thyroid Storm
5. References
   1. Burch (1993) Endocrinol Metab Clin North Am 22(2): 263-77 [PubMed]