The diagnosis of<unk>  is based on the presence of signs and symptoms consistent with severe hyperthyroidism. Multiple approaches have been proposed to calculate the probability of<unk>  based on clinical criteria, however, none have been universally adopted by clinicians. For instance, Burch and Wartofsky published the Burch-Wartofsky point scale (BWPS) in 1993, assigning a numerical value based on the presence of specific signs and symptoms organized within the following categories: temperature, cardiovascular dysfunction (including heart rate and presence of atrial fibrillation or congestive heart failure), central nervous system (CNS) dysfunction, gastrointestinal or liver dysfunction and presence of a precipitating event. A Burch-Wartofsky score below 25 is not suggestive of<unk>  whereas 25 to 45 suggests impending<unk>  and greater than 45 suggests current<unk> . Alternatively, the Japanese Thyroid Association (JTA) criteria, derived from a large cohort of patients with<unk>  in Japan and published in 2012, provide a qualitative method to determine the probability of<unk> . The JTA criteria separate the diagnosis of<unk>  into definite versus suspected based on the specific combination of signs and symptoms a patient exhibits and require elevated free triiodothyronine (T3) or free thyroxine (T4) for definite<unk> . +Burch-Wartofsky Point Scale Temperature Score Heart Rate Score Symptoms of Heart Failure Score Presence of Atrial Fibrillation Score Symptoms of CNS Dysfunction Score Gastrointestinal or Liver Dysfunction Score Presence of Precipitating Event Score 99.0 to 99.9 5 90 to 109 5 None 0 Absent 0 None 0 None 0 None 0 100.0 to 100.9 10 110 to 119 10 Mild (i.e. pedal edema) 5 Present 10 Mild (e.g. showing signs of agitation) 10 Moderate (e.g. diarrhea, nausea, vomiting or abdominal pain) 10 Present 10 101.0 to 101.9 15 120 to 129 15 Moderate (i.e. bibasilar rales) 10 Moderate (e.g. delirium, psychosis, lethargy) 20 Severe (i.e. unexplained jaundice) 20 102.0 to 102.9 20 130 to 139 20 Severe (i.e. pulmonary edema) 15 Severe (e.g. seizure or coma) 30 103 to 103.9 25 Greater than or equal to 140 25 Greater than or equal to 104 30 Laboratory findings As with hyperthyroidism, TSH is suppressed. Both free and serum (or total) T3 and T4 are elevated. An elevation in thyroid hormone levels is suggestive of<unk>  when accompanied by signs of severe hyperthyroidism but is not diagnostic as it may also correlate with uncomplicated hyperthyroidism. Moreover, serum T3 may be normal in critically ill patients due to decreased conversion of T4 to T3. Other potential abnormalities include the following: * Hyperglycemia likely due to catecholamine-mediated effects on insulin release and metabolism as well as increased glycogenolysis, evolving into hypoglycemia when glycogen<unk> s are depleted * Elevated aspartate aminotransferase (AST), bilirubin and lactate dehydrogenase (LDH) * Hypercalcemia and elevated alkaline phosphatase due to increased bone resorption * Elevated white blood cell count *
Thyroid storm
Euthyroid sick syndrome
Adrenal crisis
Pseudo-Cushing's syndrome
Postpartum thyroiditis
Subacute thyroiditis
Cushing's syndrome
Drug-induced hyperthermia