Decision Rule - Burch-Wartofsky Point Scale (BWPS) for Thyrotoxicosis

Burch-Wartofsky Point Scale for Thyrotoxicosis

Score is useful in determining the likelihood of thyrotoxicosis independent of thyroid hormone levels.

-Temperature . . . . . . . . . . . . . . .  [99-99.9°F +5; 100-100.9°F +10; 101-101.9°F +15; 102-102.9 +20; 103-103.9°F +25; ≥104°F +30]

-Central nervous system effects  . . . . .  [Absent +0; Mild (agitation) +10; Moderate (seizures, coma) +20; Severe (seizures, coma) +30]

-Gastrointestinal-hepatic dysfunction  . .  [Absent +0; Moderate (diarrhea, nausea/vomiting, abdominal pain) +10; Severe (unexplained jaundice) +20]

-Heart rate (bpm)  . . . . . . . . . . . .  [90-109 +5; 110-119 +10; 120-129 +15; 130-139 +20; ≥140 +25)

-Congestive heart failure  . . . . . . . .  [Absent +0; Mild (pedal edema) +5; Moderate (bibasilar rales) +10; Severe (pulmonary edema) +15]

-Atrial fibrillation present . . . . . . .  [No +0; Yes +10]

-Precipitating event . . . . . . . . . . .  [No +0; Yes +10]

BWPS score <25 is unlikely to represent thyroid storm, and should prompt further investigation of thyrotoxicosis (Graves disease, toxic adenoma, toxic multinodular goiter, subacute thyroiditis, exogenous levothyroxine, struma ovarii).  Consider additional imaging (thyroid ultrasound, radioactive iodine uptake and scan).

BWPS score 25-44 suggests impending thyroid storm; consider thionamides, symptom management. Consider ICU monitoring.

BWPS score ≥45 is highly suggestive of thyroid storm; consider rapid and aggressive multimodal management in ICU.

https://www.mdcalc.com/burch-wartofsky-point-scale-bwps-thyrotoxicosis