Differentiating Between Thyrotoxicosis and Thyroid Storm: Burch-Wartofsky Score

Treatment Goals:

1. Inhibition of New Thyroid Hormone Synthesis
2. Inhibition of Thyroid Hormone Release
3. Block Peripheral Effects of Thyroid Hormone
4. Prevent Peripheral Conversion of T4 to T3
5. Treat the Underlying/Precipitating Cause!

Treatment:

• Treatment regimens and dosages will vary depeding on which resource or guideline you reference. There is no general consensus on the treatment of thyroid storm.
• Ultimately, your treatment regimen may be dictated by Endocrinology at the institution at which you practice. It is recommended you discuss all patients for whom you are treating for thyroid storm with your on-call endocrinologist.
• For an up-to-date, evidence based, treatment regimen, podcast, and comment thread on Thyroid Storm see Podcast 149 - Thyroid Storm on emcrit.org.

References:

1. Burch  HB, Wartofsky  L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. 1993;22(2): 263-277.
2. Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Therapeutic Advances in Endocrinology and Metabolism. 2010;1(3): 139-145.
3. Idrose A. Hyperthyroidism. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. New York, NY: McGraw-Hill; 2016
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