Thyrotoxicosis and Choledocholithiasis Masquerading as Thyroid Storm
Table 1
Diagnostic criteria for thyroid storm established by Burch and Wartofsky. A score below 25 is unlikely to represent thyroid storm, a score between 25 and 44 is suggestive of impending thyroid storm, and a score greater than or equal to 45 is highly suggestive of thyroid storm.
Diagnostic criteria for thyroid storm adapted from Burch and Wartofsky [1]
Thermoregulatory dysfunction
Cardiovascular dysfunction
Temperature (°F)
Tachycardia (heart rate)
99–99.9
5
90–109
5
100–100.9
10
110–119
10
101–101.9
15
120–129
15
102–102.9
20
130–139
20
103–103.9
25
≥140
25
≥104.0
30
Congestive heart failure
Central nervous system effects
Absent
0
Absent
0
Mild
5
Mild
10
Pedal edema
Agitation
Moderate
10
Moderate
20
Bibasilar rales
Delirium, psychosis, extreme lethargy
Severe
15
Severe
30
Pulmonary edema
Seizure, coma
Atrial fibrillation
Gastrointestinal-hepatic dysfunction
Absent
0
Absent
0
Present
10
Moderate
10
Precipitant history
Diarrhea, nausea/vomiting, abdominal pain
Negative
0
Severe
20
Positive
10
Unexplained jaundice
Precipitant history includes thyroid surgery, withdrawal of antithyroid drug therapy, radioiodine therapy, vigorous thyroid palpation, iodinated contrast dyes, nonthyroidal surgery, infection, cerebrovascular accident, pulmonary thromboembolism, parturition, diabetic ketoacidosis, emotional stress, and trauma.
