one useful method of clinically diagnosing a thyroid storm is to use

Burch and Wartofsky's "diagnostic criteriae for thyroid

storm"

• General symptoms
o Fever
o Profuse sweating
o Poor feeding and weight loss
o Respiratory distress
o Fatigue (more common in older adolescents)
• GI symptoms
o Nausea and vomiting
o Diarrhea
o Abdominal pain
o Jaundice3
• Neurologic symptoms
o Anxiety (more common in older adolescents)
o Altered behavior
o Seizures, coma

Physical

Physical findings include the following:

• Fever
o Temperature consistently exceeds 38.5°C.
o Patients may progress to hyperpyrexia.
o Temperature frequently exceeds 41°C.
• Excessive sweating
• Cardiovascular signs
o Hypertension with wide pulse pressure
o Hypotension in later stages with shock
o Tachycardia disproportionate to fever
o Signs of high-output heart failure
o Cardiac arrhythmia (Supraventricular arrhythmias are
more common, [eg, atrial flutter and fibrillation], but
ventricular tachycardia may also occur.)
• Neurologic signs
o Agitation and confusion
o Hyperreflexia and transient pyramidal signs
o Tremors, seizures
o Coma
• Signs of thyrotoxicosis
o Orbital signs
o Goiter

There may be puffiness around the eyes and a characteristic stare

due to the elevation of the upper eyelids