Clinical scenario
Patients with factitious hyperthyroidism can present with
life-threatening thyrotoxicosis — thyroid storm — requiring rapid
diagnosis and emergency treatment. A Burch-Wartofsky score of
45 or aboveBWS ≥45 is highly
suggestive of thyroid storm. A score of 25–44 is suggestive of impending thyroid storm;
a score below 25 makes thyroid storm unlikely. At the ≥45 threshold, urgent escalation
to intensive care is required.
Management approach — partial overview
Immediate intensive-care supportive treatment — including airway
maintenance, oxygen supplementation when indicated, and intravenous fluids — forms
the foundation of care. High-dose antithyroid therapy is the
pharmacological core of the regimen, with alternative agents available when
contraindications exist.
The full agent selection, dosing, sequencing, and additional
interventions are contained in the structured protocol below.