🌡️ Thyroid Storm Recognition & Management (BWPS)
This tool applies the Burch-Wartofsky Point Scale (BWPS) to estimate the likelihood of thyroid storm and lays out a strictly sequenced treatment plan.
Thyroid Storm Recognition & Management (BWPS)
Temperature
Heart rate (bpm)
Atrial fibrillation
Congestive heart failure
Central nervous system
GI-hepatic
Precipitant
When to use
Use when thyrotoxicosis is severe: a BWPS ≥ 45 suggests storm, 25–44 is impending, and < 25 is unsupportive — but treatment is driven by clinical judgment, not by waiting for a threshold.
How it works
BWPS sums temperature, heart rate, atrial fibrillation, heart failure, CNS, GI-hepatic, and precipitant points. Storm management order: PTU → iodine (≥ 1 h later) → glucocorticoid → β-blocker → supportive care; plasma exchange if refractory.
Key points
- Inorganic iodine must be given at least an hour after the antithyroid drug, or it can fuel hormone synthesis instead of blocking release. (original synthesis · not guideline verbatim)
- Propranolol is avoided in severe heart failure, where a β1-selective agent or esmolol is used.
- Glucocorticoids both treat the storm and guard against concurrent adrenal crisis.
References
- Burch HB, Wartofsky L. Life-threatening thyrotoxicosis: thyroid storm. Endocrinol Metab Clin North Am 1993.
- Ross DS, et al. 2016 ATA Guidelines for Diagnosis and Management of Hyperthyroidism (thyroid storm). Thyroid 2016.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.