Calcular

Burch-Wartofsky Point Scale (BWPS) for Thyrotoxicosis

The Burch‑Wartofsky Point Scale quantifies the severity of thyrotoxic symptoms to help identify thyroid storm.

Temperature °F (°C)

< 99 (37.2)099–99.9 (37.2-37.7)+5100–100.9 (37.8-38.2)+10101–101.9 (38.3-38.8)+15102–102.9 (38.9-39.2)+20103–103.9 (39.3-39.9)+25≥ 104.0 (≥ 40.0)+30

Central nervous system effects

Absent0Mild (agitation)+10Moderate (delirium, psychosis, extreme lethargy)+20Severe (seizures, coma)+30

GI-hepatic dysfunction

Absent0Moderate (diarrhea, nausea, vomiting, abdominal pain)+10Severe (unexplained jaundice)+20

Heart rate (bpm)

< 90090-109+5110-119+10120-129+15130-139+20≥ 140+25

CHF

Absent0Mild (pedal edema)+5Moderate (bibasilar rales)+10Severe (pulmonary edema)+15

AFib present

No0

Yes+10

Precipitating event

No0

Yes+10

Indicaciones de Uso

Used when suspecting thyroid storm in any thyrotoxic patient with fever, tachycardia, CNS changes, heart failure, or GI/hepatic dysfunction to quantify severity and support diagnosis. Provides structured clinical scoring that correlates well with Japanese Thyroid Association criteria for identifying definite storm 1 [Level II evidence]. Helps distinguish severe thyrotoxicosis from true storm and guides urgency of therapy.

Información y Precauciones

Scores ≥45 strongly support storm, but specificity is limited and false positives occur in severe infection or other acute illnesses 1 [Level III evidence]. Use only as a clinical aid; diagnosis remains clinical and must exclude mimics like sepsis or sympathomimetic toxicity 2 [Level III evidence]. Agreement with JTA criteria is good but not perfect, and milder cases may be under‑recognized 3 [Level III evidence].