AskCalc
Home › Endocrine & Metabolic › BWPS

Burch-Wartofsky Point Scale for Thyroid Storm

The Burch-Wartofsky Point Scale (1993) scores temperature, CNS effects, GI-hepatic dysfunction, heart rate, heart failure, atrial fibrillation and a precipitant. ≥45 is highly suggestive of thyroid storm, 25–44 suggests impending storm, and <25 makes storm unlikely.

  • Temperature (°C or °F)
  • Heart rate (/min)
  • Central nervous system effects: Absent (0); Mild (agitation) (10); Moderate (delirium, psychosis, extreme lethargy) (20); Severe (seizure, coma) (30)
  • Gastrointestinal-hepatic dysfunction: Absent (0); Moderate (diarrhea, nausea/vomiting, abdominal pain) (10); Severe (unexplained jaundice) (20)
  • Heart failure: Absent (0); Mild (pedal edema) (5); Moderate (bibasilar rales) (10); Severe (pulmonary edema) (15)
  • Atrial fibrillation present (yes/no, +10)
  • Precipitating event identified (infection, surgery, iodine load, trauma, etc.) (yes/no, +10)
—

Interpretation

ResultMeaning
< 25Storm unlikely
25–44Impending storm
≥ 45Highly suggestive of thyroid storm

Formula

Temp °F 99–99.9: 5, 100–100.9: 10, 101–101.9: 15, 102–102.9: 20, 103–103.9: 25, ≥104: 30 · CNS mild 10 / moderate 20 / severe 30 · GI-hepatic moderate 10 / severe 20 · HR 90–109: 5, 110–119: 10, 120–129: 15, 130–139: 20, ≥140: 25 · CHF mild 5 / moderate 10 / severe 15 · AF 10 · precipitant 10.

Clinical pearls

  • The scale assumes biochemical thyrotoxicosis; it does not diagnose hyperthyroidism and free T4/T3 levels do not distinguish storm from uncomplicated thyrotoxicosis.
  • The score is sensitive but not specific: many hospitalized thyrotoxic patients score 25–44. Combine with clinical judgment (the Japanese Thyroid Association criteria are an alternative).

Examples

burch wartofsky temp 39 hr 125 delirium diarrhea pedal edema afib, infection triggerthyroid storm score: T 38.0, HR 112, agitation, no gi symptoms, no chf, no af, no precipitantbwps 40.2C hr 150 seizure jaundice pulmonary edema af precipitant

FAQ

What Burch-Wartofsky score indicates thyroid storm?

A score ≥ 45 is highly suggestive of thyroid storm; 25–44 suggests impending storm.

Does the Burch-Wartofsky scale require thyroid labs?

No lab values are scored, but it should only be applied to patients with confirmed thyrotoxicosis.

Evidence

  1. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am 1993;22:263–77.

Endocrine & Metabolic · Reviewed 2026-10-14 · Methodology