🦋 Thyroid Storm Emergency Simulator

The Burch-Wartofsky Point Scale — Scoring Suspected Thyroid Storm

A bedside point scale for suspected thyroid storm.

• 140: BWPS maximum score (summed across five domains)
• <25: Storm unlikely (points)
• 25–44: Impending storm (points)
• ≥45: Highly suggestive (points)

Why score before treating

Distinguishes true storm from severe thyrotoxicosis quickly.

Five scored domains

Temperature, CNS, GI/hepatic, cardiovascular, precipitant history combined.

Temperature Elevation and Central Nervous System Effects

Fever and mental status changes carry the heaviest weight.

• 30 pts: Temperature max (≥104°F (40°C))
• 30 pts: CNS effects max (agitation to coma)
• 10 pts: Mild CNS (agitation)
• 30 pts: Severe CNS (seizure or coma)

Temperature tiers

Points rise stepwise from 99°F to 104°F and above.

CNS severity tiers

Absent, mild, moderate, severe CNS disturbance each scored.

Cardiovascular Dysfunction and GI/Hepatic Involvement

Tachycardia, heart failure, and jaundice add substantial points.

• 25 pts: Tachycardia max (heart rate ≥140)
• 15 pts: CHF max (pulmonary edema)
• 10 pts: Atrial fibrillation (present)
• 20 pts: GI/hepatic max (jaundice)

Cardiovascular scoring

Heart rate, heart failure, and atrial fibrillation summed together.

GI/hepatic scoring

Nausea and vomiting score lower than unexplained jaundice.

Precipitating Event — The Trigger Behind the Crisis

A clear precipitant raises suspicion for true thyroid storm.

• 10 pts: Precipitant present (added to total)
• 0 pts: Precipitant absent (no addition)
• 4+: Common triggers (infection, surgery, DKA, labor)
• ~7%: Weight in total (of maximum score)

Identifying the trigger

Infection, surgery, trauma, or DKA often precede storm onset.

Why it matters

A trigger supports the diagnosis and guides concurrent treatment.

Total Score Interpretation — Guiding Treatment Urgency

The summed score sorts patients into three action tiers.

• <25: Storm unlikely (observe, treat cause)
• 25–44: Impending storm (close monitoring warranted)
• ≥45: Highly suggestive (aggressive storm therapy)
• 140: Score ceiling (theoretical maximum)

Reading the gauge

Needle position crosses three color-coded interpretation zones.

Clinical correlation required

High sensitivity, modest specificity — always correlate clinically.

BWPS point components at a glance