Thyroid Storm Case 1
A 34-year-old woman has recently seen her GP with tremor, palpitations and weight loss. Her GP discussed the possibility of thyrotoxicosis with her and arranged blood tests. She has not yet had the results. She came to the emergency department (ED) but she is concerned that she should be having treatment. Today she felt unwell and noticed her heart racing.
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Question 1 of 3
1. Question
What five parameters are used in a scoring system for thyroid storm?
CorrectIncorrect -
Question 2 of 3
2. Question
On further assessment, she tells you she has had loose stools for about a month. She has not had any other GI symptoms.
On examination her observations are:
- P92
- BP 140/76
- Temperature 37.4
- RR 15
- GCS 15
She is anxious and has a fine tremor. There is no palpable goitre. She does not appear dehydrated. The rest of examination is normal. ECG shows sinus rhythm and no abnormalities.
What is her Burch and Wartofsky score? Use this table to calculate your answer.
Burch and Wartofsky scoring tableTemperature 37-37.7 5 37.7-38.3 10 38.3-38.8 15 38.8-39.4 20 39.4-40 25 >40 30 Precipitant history Negative 0 Positive 10 Cardiovascular Tachycardia 90-110 5 110-120 10 120-130 15 130-140 20 >140 25 Congestive heart failure Absent 0 Mild (pedal odema) 5 Moderate (bibasal creps) 10 Severe (pulmonary odema) 15
Atrial Fibrillation 10 Central nervous system Absent 0 Mild (agitation) 10 Moderate (delirium, psychosis) 20 Severe (seizure, coma)
30 Gastrointestinal
Absent 0 Moderate (vomiting, diarrhoea and abdominal pain) 10 Severe (unexplained jaundice) 20 CorrectIncorrect -
Question 3 of 3
3. Question
Her thyroid function tests, taken by the GP, are available from the lab:
Thyroid function tests:
- TSH -Thyroid Stimulating Hormone: 0.1 (0.4-4.5 milliunits per litre)
- Total Thyroxine (T4): 250 (60-160 nanomoles per litre)
- FT4 – Free T4 (the active part of thyroxine): 35 (9-25 picomoles per litre)
- FT3 – Free T3 (the active part of triiodothyronine): 12.1 (3.5-7.8 picomoles per litre)
Does she have thyroid storm? Explain your reasoning.
CorrectIncorrect