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

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

Answer: (A)

In a thyrotoxic crisis from Graves’ disease, the body is thrust into an extreme hypermetabolic and hyperadrenergic state due to very high levels of thyroid hormone. This heightened metabolism generates excess heat, and the body's heat-dissipation mechanisms are overwhelmed, leading to fever. Fever is a hallmark sign because it reflects the systemic surge in metabolic activity and heat production that accompanies a thyroid storm, along with other features like rapid heart rate, sweating, tremor, and agitation.

Pallor isn’t typical in this crisis; you often see warm, sweaty skin from the sympathetic surge. Bradycardia would go against the expected tachycardia of a thyrotoxic state, and weight gain isn’t characteristic—weight loss from accelerated metabolism is more common in hyperthyroid conditions and especially in a crisis.