Diagnostic Criteria for Thyroid Storm

Burch and Wartofsky have delineated a point system assessing degrees of dysfunction in various systems (thermoregulatory, central nervous, gastrointestinal, and cardiovascular).

Diagnostic parameters Scoring points
Thermoregulatory dysfunction
Temperature °F (°C)
99–99.9 (37.2-37.7)
100–100.9 (37.8-38.2)
101–101.9 (38.3-38.8)
102–102.9 (38.9-39.2)
103–103.9 (39.3-39.9)
>/= 104.0 (>/= 40.0)
5
10
15
20
25
30
Central nervous system effects
Absent
Mild (agitation)
Moderate (delirium, psychosis, extreme lethargy
Severe (seizures, coma)
0
10
20
30
Gastrointestinal-hepatic dysfunction
Absent
Moderate (diarrhea, nausea/vomiting, abdominal pain)
Severe (unexplained jaundice)
0
10
20
Cardiovascular dysfunction
Tachycardia (beats/minute)
90–109
110–119
120–129
130–139
>/= 140
5
10
15
20
25
Congestive heart failure
Absent
Mild (pedal edema)
Moderate (bibasilar rales)
Severe (pulmonary edema)
0
5
10
15
Atrial fibrillation
Absent
Present
Precipitating event
Absent
Present
0
100
10

Scoring system: A score of 45 or greater is highly suggestive of thyroid storm; a score of 25–44 is suggestive of impending storm, and a score below 25 is unlikely to represent thyroid storm.

 

 

References:

  1. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993;22:263–77 [Medline]
  2. Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006 Dec;35(4):663-86. [Medline]
  3. De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016 Aug 27;388(10047):906-918. [Medline]

 

Created Sep 18, 2009