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:
- Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993;22:263–77 [Medline]
- Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006 Dec;35(4):663-86. [Medline]
- De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016 Aug 27;388(10047):906-918. [Medline]
Created Sep 18, 2009
