What goes into the Burch-Wartofsky score
- Temperature: < 99 °F (< 37.2 °C) (0); 99–99.9 °F (5); 100–100.9 °F (10); 101–101.9 °F (15); 102–102.9 °F (20); 103–103.9 °F (25); ≥ 104 °F (≥ 40 °C) (30)
- CNS effects: Absent (0); Mild agitation (10); Delirium, psychosis or extreme lethargy (20); Seizure or coma (30)
- GI or hepatic dysfunction: Absent (0); Diarrhea, nausea, vomiting or abdominal pain (10); Unexplained jaundice (20)
- Heart rate: < 90 (0); 90–109 (5); 110–119 (10); 120–129 (15); 130–139 (20); ≥ 140 (25)
- Heart failure: Absent (0); Mild (pedal edema) (5); Moderate (bibasilar rales) (10); Severe (pulmonary edema) (15)
- Atrial fibrillation (+10)
- Precipitating event identified (+10)
How to interpret the result
- ≥ 45: highly suggestive of thyroid storm
- 25–44: impending storm
- < 25: storm unlikely
Clinical pearls
- The score is clinical; thyroid hormone levels do not distinguish storm from uncomplicated thyrotoxicosis.
- Give iodine at least 1 hour after the thionamide.
- The Japan Thyroid Association criteria are an alternative.
Evidence
- Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. 1993;22:263-277.
Related workups
Related calculators
For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.