Q: Should treatment be delayed if the BW score is <45?

No. A low score does not rule out early or atypical storm. If the clinical suspicion is high (e.g., unexplained fever+tachycardia in a known thyrotoxic patient), treatment should be initiated while further investigations proceed.

Q: How quickly should I reassess after starting treatment?

Reassess clinical status and the BW score within 12–24 hours. Fever and tachycardia should improve within hours of starting beta-blockade and anti-thyroid therapy. Worsening or no improvement should prompt escalation.

Question 1

Can I use the BW score in patients already on beta-blockers?

Accepted Answer

Yes, but note that pre-existing beta-blocker therapy will blunt the heart-rate component. The score can still be used; the cardiovascular subscore should be interpreted with this caveat in mind.

Question 2

What are the most common precipitants of thyroid storm?

Accepted Answer

Infection, trauma, surgery (especially thyroid surgery in the unprepared patient), acute iodine load (contrast, amiodarone), parturition, and abrupt cessation of anti-thyroid drugs.

Question 3

Should treatment be delayed if the BW score is <45?

Accepted Answer

No. A low score does not rule out early or atypical storm. If the clinical suspicion is high (e.g., unexplained fever+tachycardia in a known thyrotoxic patient), treatment should be initiated while further investigations proceed.

Question 4

How quickly should I reassess after starting treatment?

Accepted Answer

Reassess clinical status and the BW score within 12–24 hours. Fever and tachycardia should improve within hours of starting beta-blockade and anti-thyroid therapy. Worsening or no improvement should prompt escalation.