What BWPS score indicates thyroid storm vs impending storm?

BWPS ≥45: thyroid storm; BWPS 25-44: impending thyroid storm (empirically treat as storm); BWPS <25: unlikely thyroid storm; false negatives possible with absent precipitant, so treat based on clinical suspicion too.

What is the treatment sequence for thyroid storm?

1) PTU 500-1000 mg loading dose (blocks T4→T3 conversion); 2) 1-2 hours later: potassium iodide or Lugol solution (SSKI/KI blocks release - must follow PTU/methimazole); 3) Beta-blocker (propranolol or esmolol); 4) Glucocorticoids (hydrocortisone 300 mg IV then 100 mg q8h).

Why must PTU be given before iodine in thyroid storm?

Iodine given before PTU/methimazole can acutely worsen thyrotoxicosis by providing substrate for continued thyroid hormone synthesis (Jod-Basedow effect); PTU blocks new hormone synthesis first, then iodine safely blocks hormone release.

What beta-blocker dosing is used in thyroid storm?

Propranolol 60-80 mg PO/NGT q4-6h; IV propranolol 0.5-1 mg IV over 10-15 min q4h; esmolol infusion 50-100 mcg/kg/min for severe tachycardia; avoid esmolol if significant cardiac dysfunction.

What complications should be monitored in thyroid storm ICU management?

High-output cardiac failure (hyperdynamic circulation exhausting cardiac reserve), ventricular arrhythmias, hyperthermia requiring cooling, hepatic failure (from PTU hepatotoxicity - prefer methimazole after 24-48h if possible), adrenal insufficiency.

Thyroid Storm Burch-Wartofsky Point Scale (BWPS)

Calculates Burch-Wartofsky Point Scale for thyroid storm severity, integrating temperature, cardiovascular dysfunction, CNS effects, GI manifestations, and precipitating event to guide PTU/methimazole, iodine, and beta-blocker dosing.

Weight

Height

Clinical Guidance

BMI is a screening measure of body size, not a direct measure of body fat. The standard WHO categories are underweight (<18.5), normal (18.5–24.9), overweight (25–29.9), and obese (≥30).

BMI can overestimate body fat in athletes with high muscle mass and underestimate it in older adults with low muscle mass. Interpret it alongside waist circumference and clinical context rather than as a standalone diagnosis.

⚕ Clinical Disclaimer: These calculators are for educational and reference purposes only. Always verify results with qualified clinical judgment and current clinical guidelines. Do not use as a sole basis for medical decisions.

How to Use

Enter the values for the patient or scenario you are assessing. Calculates Burch-Wartofsky Point Scale for thyroid storm severity, integrating temperature, cardiovascular dysfunction, CNS effects, GI manifestations, and precipitating event to guide PTU/methimazole, iodine, and beta-blocker dosing. Use the thyroid storm bwps result to inform your clinical assessment.

Related Calculators

SOFA Score

Medical

RASS Score

Medical Calculators

MAP Target ICU