Endocrine Abstracts

Introduction: Thyroid storm, a life-threatening endocrine emergency, requires prompt intervention and treatment to improve outcomes. The diagnosis is made clinically, based on symptoms including hyperpyrexia, tachycardia, nausea, diarrhoea and altered cognition. The Burch-Wartofsky (BW) score is a symptom-based score recommended to determine the likelihood of thyroid storm. This retrospective study aims to determine use of the BW scale and its effect on management.

Data collection: The CHI numbers of inpatients with significantly elevated fT4 (>25 pmo/l) at the QEUH labs between Jan-21 and Nov-21 were obtained via Laboratory Information System (LIMS) search. Patients in the maternity, oncology unit, on levothyroxine or with detectable TSH were excluded. Information included: descriptive characteristics, TSH, antibody status and acute diagnosis/treatment. BW score and outcome, was retrospectively calculated using patient notes.

Results: BW score was used clinically in 1/51 patients included. Most patients were diagnosed clinically with “acute thyrotoxicosis,” however, the opinion of an endocrinologist was not always sought. Of 29 patients with a BW score indicating ‘storm unlikely’ none were clinically identified at risk of deterioration. Of 15 patients with a BW score suggesting ‘impending storm’, 1 was identified clinically as impending storm. Of 7 patients with a BW score indicating ‘thyroid storm’, 2 were clinically diagnosed with thyroid storm. BW score never suggested a less severe diagnosis, in 6 instances the BW score suggested a more severe diagnosis than the clinical decision. A weak positive correlation between BW score and fT4 was noted (spearman co-efficient: 0.28, P<0.05).

Conclusions: The use of the BW score in clinical practice would standardise classification of patients; subsequently, identifying patients at higher risk of clinical deterioration, requiring prompt treatment. As a result of this first audit cycle, we are discussing with clinical biochemistry issuing reports to recommend endocrinology review and encourage use of BW scale where appropriate.