Burch-Wartofsky Point Scale for Thyrotoxicosis
Scoring system for diagnosing thyroid storm (thyrotoxic crisis) and guiding treatment urgency. Score ≥ 45 is diagnostic of thyroid storm.
Score interpretation
BWPS < 25: Thyroid storm unlikely. Possible simple thyrotoxicosis.
→ Treat symptomatic hyperthyroidism: propranolol 40–80mg TDS for symptom control. Carbimazole 20–40mg/day or PTU. Check TFTs, thyroid antibodies, USS. Endocrinology outpatient referral.
BWPS 25–44: Impending thyroid storm. Aggressive medical management required.
→ Admit. IV propranolol (or atenolol) for rate control. Carbimazole 20–30mg stat then 10–15mg 6-hourly OR PTU 200mg QDS. After 1 hour: Lugol's iodine (5 drops TDS) — NEVER before thionamide. Hydrocortisone 100mg IV 6-hourly (inhibits T4→T3 conversion). Treat precipitant. Endocrinology review.
BWPS ≥ 45: Thyroid storm. Life-threatening emergency. Mortality 10–30%.
→ ICU admission. Propranolol IV 0.5–1mg slow IV (cardiac monitoring). PTU 500–1000mg stat then 250mg 4-hourly (preferred over carbimazole in storm). After 1h: Lugol's iodine 10 drops 8-hourly. IV hydrocortisone 100mg 6-hourly. Active cooling (paracetamol — avoid aspirin/NSAIDs). Treat precipitant aggressively. Cholestyramine 4g QDS to reduce enterohepatic circulation. Consider plasmapheresis if refractory.
Interpretation bands for the BWPS. Apply clinical judgement and local guidance.
References
- Burch HB, Wartofsky L. Life-threatening thyrotoxicosis: thyroid storm. Endocrinol Metab Clin North Am. 1993.
- NICE CKS. Hyperthyroidism. 2022.
Related
Curated clinical cross-links plus same-class fallbacks.
- Potassium Iodide / Lugol's Solution · Thyroid Blocking Agent / Pre-operative Thyroid Preparation
- Iodide with iodine (Lugol's solution) · Antithyroid (preoperative)
- Tocilizumab (ICU — Cytokine Storm / COVID-19) · IL-6 Receptor Inhibitor
- Amiodarone Hydrochloride · Class III Antiarrhythmic (Iodine-containing)
- Povidone-iodine · Iodophor antiseptic
- Levothyroxine · Thyroid Hormone
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.