Thyroid storm scoring using the Burch-Wartofsky Point Scale assigns points across several domains. Which of the following combinations of findings yields the HIGHEST point total in a single patient?
- A Temperature 38.5°C, HR 110 bpm, mild agitation, no atrial fibrillation, no heart failure
- B Temperature 40°C, HR 140 bpm, seizures, atrial fibrillation, pulmonary oedema ✓
- C Temperature 39°C, HR 130 bpm, psychosis, no atrial fibrillation, mild heart failure
- D Temperature 38°C, HR 100 bpm, delirium, atrial fibrillation, moderate heart failure
Correct answer: B. Temperature 40°C, HR 140 bpm, seizures, atrial fibrillation, pulmonary oedema
Explanation
The Burch-Wartofsky scale scores temperature (≥40°C = 30 pts), HR (≥140 = 25 pts), CNS dysfunction (seizure/coma = 30 pts), precipitant (present = 10 pts), heart failure (pulmonary oedema = 20 pts), and AF (10 pts). Option B yields: 30 + 25 + 30 + 10 + 20 = 115 points, the highest possible combination among the choices. A score ≥45 diagnoses thyroid storm; option B far exceeds this threshold. Options A, C and D accrue significantly fewer points due to lower temperatures, heart rates, and CNS dysfunction scores.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.