MON-371 Burch-Wartofsky Point Scale as a Prognostic Indicator in Thyroid Storm: A Retrospective Study

Abstract Disclosure: T. Nagamine: None. S. Kobayashi: None. M. Nagao: None. I. Fukuda: None. M. Iwabu: None. Background: Thyroid storm is a life-threatening condition caused by thyrotoxicosis and is one of the most critical emergencies in endocrinology. Despite its severity, prognostic tools to guide early management remain limited. This study aims to evaluate the effectiveness of commonly used severity scoring systems in predicting the prognosis of thyroid storm at diagnosis to facilitate timely multidisciplinary interventions for high-risk patients. Methods: A retrospective analysis was conducted on 22 patients diagnosed with thyroid storm (M/F=8/14; mean age: 50.5 ± 15.5 years) and admitted to our hospital between January 2012 and November 2024. Among the 22 patients, 21 had Graves' disease, and 1 had an autonomously functioning thyroid nodule as the underlying cause. Patients were stratified into poor prognosis (death or resuscitation after cardiopulmonary arrest) and normal prognosis groups based on outcomes. Prognostic accuracy was compared among four severity scoring systems assessed at admission: APACHE II (Acute Physiology and Chronic Health Evaluation II), a severity index for patients admitted to the intensive care unit; SOFA (Sequential Organ Failure Assessment), a severity index for patients with multiple organ failure; qSOFA (Quick SOFA), a screening tool for sepsis; and the Burch-Wartofsky Point Scale (BWPS), used to diagnose thyroid storm. Results: Four patients were categorized in the poor prognosis group (3 deaths and 1 resuscitation), while 18 were classified as having a normal prognosis. Median (IQR) scores for the poor prognosis vs. normal prognosis groups were as follows: APACHE II: 29 (25.5-31.8) vs. 15 (10-22), SOFA: 12 (6.8-16) vs. 3 (2-5), qSOFA: 3 (2.5-3) vs. 1 (0-2), and BWPS: 112.5 (108.8-120) vs. 75 (70-80). All scores were significantly higher in the poor prognosis group (p<0.05 for APACHE II, SOFA, and qSOFA; p<0.01 for BWPS). The BWPS cutoff value of 95 demonstrated the highest prognostic accuracy, with 100% sensitivity and 94% specificity based on ROC curve analysis. Conclusion: A BWPS score ≥95 is a critical threshold for identifying thyroid storm patients at risk for poor prognosis. These findings emphasize the need for urgent referral to specialized care facilities or early initiation of plasma exchange in patients at risk for poor prognosis. Adoption of this cutoff value could significantly improve prognostic assessment and management strategies for thyroid storm. Presentation: Monday, July 14, 2025