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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Burch-Wartofsky Point Scale (BWPS) for Thyrotoxicosis

    Predicts likelihood that biochemical thyrotoxicosis is thyroid storm.

    INSTRUCTIONS

    Use in patients ≥18 years old with biochemical thyrotoxicosis.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with thyrotoxicosis in the setting of systemic decompensation.

    • The Burch-Wartofsky Point Scale (BWPS) is a quantitative diagnostic tool based on 3 major observations in patients with thyroid storm:
      • Continuum of end organ dysfunction.
      • High variability of symptoms and signs between patients.
      • High mortality associated with missed diagnosis.
    • Assigns points for dysfunction of thermoregulatory, GI, cardiovascular, and central nervous systems.
    • Given the high mortality/morbidity associated with thyroid storm, the BWPS intentionally utilizes liberal criteria, which may also lead to false-positives.
    • Elderly patients may present with apathetic thyrotoxicosis with atypical symptoms (weakness, memory loss, obtundation, cardiac failure).
    • Serum levels of T4 and T3 do NOT correlate with severity of thyrotoxicosis.
    • Presence of jaundice suggests especially poor prognosis.
    • Ultimately, thyroid storm is a clinical diagnosis and requires prompt recognition and treatment.

    Can help distinguish uncomplicated thyrotoxicosis from “impending” storm or established thyroid storm.

    <99
    0
    99–99.9 (37.2-37.7)
    +5
    100–100.9 (37.8-38.2)
    +10
    101–101.9 (38.3-38.8)
    +15
    102–102.9 (38.9-39.2)
    +20
    103–103.9 (39.3-39.9)
    +25
    ≥104.0 (≥ 40.0)
    +30
    Absent
    0
    Mild (agitation)
    +10
    Moderate (delirium, psychosis, extreme lethargy)
    +20
    Severe (seizures, coma)
    +30
    Absent
    0
    Moderate (diarrhea, nausea/vomiting, abdominal pain)
    +10
    Severe (unexplained jaundice)
    +20
    <90
    0
    90-109
    +5
    110-119
    +10
    120-129
    +15
    130-139
    +20
    ≥140
    +25
    Absent
    0
    Mild (pedal edema)
    +5
    Moderate (bibasilar rales)
    +10
    Severe (pulmonary edema)
    +15
    No
    0
    Yes
    +10
    No
    0
    Yes
    +10

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Henry Burch

    About the Creator

    Henry Burch, MD, is an endocrinologist at the National Naval Medical Center in Bethesda, Maryland. He is one of two doctors at National Naval Medical Center who specialize in Endocrinology, Diabetes & Metabolism. His research interests include diagnosis and treatment of thyroid disorders.

    To view Dr. Henry Burch's publications, visit PubMed

    Are you Dr. Henry Burch? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Anika Anam, MD
    About the Creator
    Dr. Henry Burch
    Are you Dr. Henry Burch?
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