Treatment of Hyperthyroidism in Thyroid Storm — Burch-Wartofsky Score 45 or Greater
Clinical Scenario
This protocol targets severe hyperthyroidism presenting as thyroid storm, defined by a Burch-Wartofsky score of 45 or greater. A score at this threshold is highly suggestive of thyroid storm; scores of 25–44 suggest impending storm, while scores below 25 make the diagnosis unlikely.
Graves disease, toxic adenoma, and toxic multinodular goiter can all precipitate this life-threatening syndrome.
Management Overview
Management requires concurrent supportive measures alongside targeted interventions aimed at interrupting thyroid hormone synthesis, blocking hormone release, controlling cardiovascular effects, and treating the underlying precipitating cause.
The complete sequenced regimen — including agent selection and step-by-step approach — is available via the link below.
References
- Graves disease, toxic adenoma, and toxic multinodular goiter can sometimes cause severe hyperthyroidism, which is termed a thyroid storm.
- A score of 45 or greater is highly suggestive of thyroid storm, a score of 25 to 44 is suggestive of impending storm, and a score below 25 is unlikely to represent thyroid storm.
- Airway maintenance
- Oxygen
- IV fluids
- Cooling blanket (do not use salicylate to treat fever because salicylates increase free T4 and free T3 levels)
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