TABLE 4.
DIAGNOSTIC CRITERIA FOR THYROTOXIC CRISIS
| Points | ||||
|---|---|---|---|---|
| Thermoregulatory dysfunction | ||||
| Temperature (°F): | 99–99.9 | 5 | ||
| 100–100.9 | 10 | |||
| 101–101.9 | 15 | |||
| 102–102.9 | 20 | |||
| 103–103.9 | 25 | |||
| ≥104 | 30 | |||
| Central nervous system effects | ||||
| Absent | 0 | |||
| Mild agitation | 10 | |||
| Delirium, psychosis, lethargy | 20 | |||
| Seizure or coma | 30 | |||
| Gastrointestinal dysfunction | ||||
| Absent | 0 | |||
| Diarrhea, nausea, vomiting, or abdominal pain | 10 | |||
| Unexplained jaundice | 20 | |||
| Cardiovascular dysfunction | ||||
| Tachycardia (beats/min): | 90–109 | 5 | ||
| 110–119 | 10 | |||
| 120–129 | 15 | |||
| 130–139 | 20 | |||
| ≥140 | 25 | |||
| Congestive heart failure: | Absent | 0 | ||
| Mild (edema) | 5 | |||
| Moderate (bibasilar rales) | 10 | |||
| Severe (pulmonary edema) | 15 | |||
| Atrial fibrillation: | Absent | 0 | ||
| Present | 10 | |||
| History of precipitating event (surgery, infection, etc.) | ||||
| Absent | 0 | |||
| Present | 10 | |||
Points are assigned and the score totaled. When not possible to distinguish a finding due to an intercurrent illness from that of thyrotoxicosis, a higher point score is given in order to favor empiric therapy given the potential high mortality.
Interpretation: Based on the total score, the likelihood of the diagnosis of thyrotoxic storm is unlikely if <25, impending if between 25–44, likely if between 45–60, and highly likely if >60.