Treatment of Factitious Hyperthyroidism in Thyroid Storm (Burch-Wartofsky Score ≥45)
Thyroid storm is a life-threatening form of thyrotoxicosis that demands rapid recognition and emergency management. In factitious hyperthyroidism, a Burch-Wartofsky score of 45 or above is highly suggestive of this critical presentation and triggers a specific, urgent treatment pathway.
Clinical Scenario
Patients with hyperthyroidism can develop life-threatening thyrotoxicosis — thyroid storm — requiring immediate diagnosis and emergency treatment. A Burch-Wartofsky score of ≥45 is highly suggestive of thyroid storm; a score of 25–44 indicates impending thyroid storm; a score below 25 makes the diagnosis unlikely.
Treatment Approach (Partial Overview)
Early definitive therapy is indicated for all patients with thyroid storm in this setting, with the choice of modality guided by individual patient factors — including goiter characteristics and contraindications. The full decision criteria, sequencing, and surgical considerations are available in the complete protocol.
References
- Patients with hyperthyroidism can present with life-threatening thyrotoxicosis or 'thyroid storm' requiring rapid diagnosis and emergency treatment.
- A score of ≥45 is highly suggestive of thyroid storm, a score of 25-44 is suggestive of impending thyroid storm and a score <25 is unlikely to represent thyroid storm.
- All patients with thyroid storm should have early definitive therapy with radioactive iodine or total thyroidectomy.
- In patients with large obstructing goiter or contraindications to radioactive iodine therapy, early total thyroidectomy should be considered.
DOI: 10.1089/thy.2016.0229
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