Introduction
The diagnosis of thyroid storm is a clinical one. The clinical state resembles that of a hyperadrenergic state. There is no cut off for thyroid hormone levels which defines thyroid storm or differentiates it from severe thyrotoxicosis.
The scoring system (below) can be used to aid diagnosis but if a patient exhibits signs of severe thyrotoxicosis it is safer to assume that thyroid storm may be imminent and manage the patient aggressively.
Scoring system for thyroid crisis by Burch and Wartofsky [4]
This uses a numerical score to predict the presence of thyroid storm with categories of unlikely, impending and diagnostic. Five features are assessed to give an overall score:
Thermoregulatory dysfunction
|
Temperature oC |
Score |
| 37-37.7 | 5 |
| 37.7-38.3 | 10 |
| 38.3-38.8 | 15 |
| 38.8-39.4 | 20 |
| 39.4-40 | 25 |
| >40 | 30 |
Cardiovascular Dysfunction
| Tachycardia | Score |
| 90-110 | 5 |
| 110-120 | 10 |
| 120-130 | 15 |
| 130-140 | 20 |
| >140 | 25 |
| Congestive heart failure absent | 0 |
| Mild CHF (pedal oedema) | 5 |
| Moderate CHF (bibasal creps) | 10 |
| Severe CHF (pulmonary oedema) | 15 |
| Atrial fibrillation | 10 |
Central Nervous System Effects
| Absent | 0 |
| Mild (agitation) | 10 |
| Moderate (delirium, psychosis) | 20 |
| Severe (seizure, coma) | 30 |
Gastrointestinal effects
| Absent | 0 |
| Moderate (vomiting, diarrhoea and abdominal pain) | 10 |
| Severe (unexplained jaundice) | 20 |
Precipitant history
| Negative | 0 |
| Positive | 10 |
Likelihood of thyroid storm
| >45 | Highly suggestive |
| 25-44 | Impending storm |
| <25 | Unlikely |