Which of the following is a sign of thyrotoxic crisis in Graves' disease?

• A. Pallor
• B. Bradycardia
• C. Weight gain
• D. Fever

Answer: (D)

A thyroid storm in Graves’ disease is an extreme, life-threatening surge of thyroid hormone that drives a hypermetabolic state. Fever fits this picture because heat production skyrockets with the body’s metabolic rate, and the thermoregulatory system is overwhelmed. The crisis is often precipitated by stress or infection, so fever is a common and telling sign of this acute decompensation.

Other options don’t align with the storm profile: pallor isn’t typical—instead, you often see warm, sweating skin due to increased blood flow. Bradycardia would be opposite of the tachycardia that accompanies thyrotoxic crisis. Weight gain would not occur; the hypermetabolism usually causes weight loss. So fever stands out as a hallmark clue for a thyrotoxic crisis.