Download Table | The Burch-Wartofsky Point Scale for diagnosis of thyroid storm Based on the diagnostic criteria of Burch and Wartofsky for thyroid storm. Burch and Wartofsky have published precise criteria and a scoring system for the diagnosis of thyroid storm based on clinical features. General. Work-Up; Burch & Wartofsky Diagnostic Criteria. 5 Management. Supportive care; Treat Increased Adrenergic Tone; Block.

Author: Vugis Kagajora
Country: Dominican Republic
Language: English (Spanish)
Genre: Education
Published (Last): 22 May 2006
Pages: 413
PDF File Size: 1.20 Mb
ePub File Size: 4.97 Mb
ISBN: 339-7-47910-759-7
Downloads: 63904
Price: Free* [*Free Regsitration Required]
Uploader: Nazil

Several conditions could simulate an inappropriate thyroid function and differential diagnoses [anaphylactic reaction, malignant hyperthermia, brain wartofskky, phaeochromocytoma, neuroleptic malignant syndrome or untreated hypertension 8 ] could determine an inappropriate management delay.

For these reasons, in all patients with know or unknown abnormal thyroid function wartofwky to surgical procedures is necessary to assess the compliance to the prescribed therapy and to optimize hormonal secretion, to settle the better endocrinal function at hospitalization.

Case of sorafenib-induced thyroid storm. The guidelines for the management of TS in order to increase the accuracy of clinical diagnosis recommend use of both diagnostic systems to evaluate patients The authors have no conflicts of interest to declare.

The major challenges of an intraoperative TS onset are due to several conditions that could mimic a cardiovascular collapse with wartovsky signs such as pain, electrolytes disturbances, malignant hyperthermia, heart failure and anaphylactic reactions 7.

Thyroid storm

Endocrinology and Metabolism Burfh of North America. A Fundamental and Clinical Text 10th. Open in a separate window. Corticosteroids The hypermetabolic state burfh to TS could generate a depletion of stress hormones and corticosteroids should be administered as prophylaxis for related adrenal insufficiency.

Occurrence is main frequent into female gender with wartofksy ratio female: Abstract Thyroid storm TS is an endocrine emergency characterized by rapid deterioration, associated with high mortality rate therefore rapid diagnosis and emergent treatment is mandatory.


Acetaminophen is the first choice and all mechanical refrigeration techniques such as cooling blankets or ice packs should be used in TS patients with resistant fever. Thyrotoxic storm management The pillar of TS management is to treat the hormonal sclre excretion starting prematurely all supportive maneuvers. Infections, with fever onset, could manifest TS 2 and a precocious antibiotic therapy has to be applied on patients with suspected thyroid disease before sepsis signs are evident The Japan Thyroid Association and Japan Endocrine Society taskforce committee conducted nationwide surveys and developed new diagnostic criteria for TS, in addition to Burch and Wartofsky scale 3 Thyroid storm during pregnancy.

It can also occur during the intra-op period as a result of uncontrolled follicular cells secretion.

Burch-Wartofsky-Score – DocCheck Flexikon

Besides reducing T4 to T3 conversion, steroids provide adrenal support, which can be impaired in thyroid storm. Alternative drugs for resistant convulsions are fosphenytoin, phenobarbital and sodium thiopental Figure 2 Numerical inputs and outputs Formula.

Algorithm for the treatment of convulsion in patients with thyroid storm. Life-threatening thyrotoxicosis induced by amiodarone in patients with benign heart disease. The guideline for epilepsy treatment Therapeutic Guideline for Sepsis Otherwise, the onset rate correlated to endocrine surgery is decreasing according to recent preoperative indications that create an euthyroid state before performing surgery 6.

Review of cases.

Predictive features associated with thyrotoxic storm and management

Endocrinol Metab Clin North Am ; J Clin Invest ; The main action of ATDs is the direct inhibition of thyroid peroxidase in the thyroid gland, with reduction of synthesis of new hormone. The presence of heart collapse, coagulation abnormalities and organ failure determines a poor outcome and all the therapeutic strategies are involved to reduce hormonal activity, to prevent organ wagtofsky and to sustain vital capacity. Target treatment towards thyroid hormone formation, release, and adrenergic action: Critical Actions Iodine therapy should be administered at least 1 hour AFTER thionamides sscore prevent stimulation of new thyroid hormone synthesis Avoid aspirin because it displaces T4 from thyroid binding globulin, resulting in increase of free T4.


Burch HB, Wartofsky L.

Predictive features associated with thyrotoxic storm and management

The BWPS is based on a retrospective analysis of patients diagnosed with thyroid storm and was validated retrospectively against their medical records. Bucrh Japanese Thyroid Association Akamizu et al published an alternative system derived from literature review of thyroid storm cases and Japanese patients with thyroid storm in Administration of endovenous vasoactive drugs and diuretics should be considered in order to maintain cardiovascular tone, to reduce venous return.

Additionally, pregnancy and post-partum period are triggering factors to develop TS due to redefinition of autoimmunity state 4. Triggering conditions could be drugs such as amiodarone, sorafenib, ipilimumab and inappropriate hormone ingestion 13 – 15 or medical settings as surgery, radioiodine therapy and exposure to excess iodine in patients with hyperthyroidism 2516 Anesthetic implications of concurrent diseases.

During budch period a complete physical exam, focusing on cardiovascular signs, could suggests a wartlfsky suspicion for thyrotoxicosis permitting to prevent perioperative systemic organ failure related to inappropriate hormonal excretion.