Thyroid Storm Recognition & Management (BWPS) — free guideline decision tool

This tool applies the Burch-Wartofsky Point Scale (BWPS) to estimate the likelihood of thyroid storm and lays out a strictly sequenced treatment plan.

BWPS sums temperature, heart rate, atrial fibrillation, heart failure, CNS, GI-hepatic, and precipitant points. → iodine → glucocorticoid → β-blocker → supportive care; plasma exchange if refractory.

Use when thyrotoxicosis is severe: a BWPS ≥ 45 suggests storm, 25–44 is impending, and < 25 is unsupportive — but treatment is driven by clinical judgment, not by waiting for a threshold.

(original synthesis · not guideline verbatim) Glucocorticoids both treat the storm and guard against concurrent adrenal crisis.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.

Inputs: Temperature 38.3–38.8°C, Heart rate (bpm) 110–119, Atrial fibrillation No, Congestive heart failure Mild (pedal edema), Central nervous system Mild (agitation), GI-hepatic Moderate (diarrhea/nausea-vomiting/abdominal pain), Precipitant None → Result: BWPS score 50 pts（Decision: Suggestive of thyroid storm (< 25 unsupportive / 25–44 impending / ≥ 45 storm), Management: (5) cooling (avoid aspirin), fluids, correct electrolytes, sedation, treat precipitant (e.g. infection); if refractory → plasma exchange, Key point: Iodine must be given after ATD, otherwise it may worsen; glucocorticoid also guards against adrenal crisis） Inputs: Temperature < 37.2°C, Heart rate (bpm) < 99, Atrial fibrillation No, Congestive heart failure None, Central nervous system None, GI-hepatic None, Precipitant None → Result: BWPS score 0 pts（Decision: Does not support thyroid storm (< 25 unsupportive / 25–44 impending / ≥ 45 storm), Management: Below the storm threshold: manage as hyperthyroidism/thyrotoxicosis per protocol with close monitoring, watching for progression to storm; actively remove/treat precipitants, Key point: Iodine must be given after ATD, otherwise it may worsen; glucocorticoid also guards against adrenal crisis）