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

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

Answer: (C)

Thyrotoxic crisis, or thyroid storm, is an extreme hypermetabolic state driven by an oversupply of thyroid hormone. That surge pushes heat production and sympathetic nervous system activity to the extreme, so the body overheats, leading to fever. This fever reflects the dramatic increase in metabolic rate and heat generation characteristic of the crisis. Other features like pallor, bradycardia, or weight gain don’t fit this picture—weight loss is common due to accelerated metabolism, bradycardia is the opposite of what occurs (tachycardia is typical), and pallor isn’t a defining sign. In addition to fever, you’d expect marked tachycardia, tremor, sweating, agitation, and GI symptoms, all pointing to thyroid storm rather than a minor thyroid imbalance. Fever is the best fit because it directly signals the hypermetabolic, thermogenic state of the crisis.