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

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

Answer: (D)

Thyrotoxic crisis, or thyroid storm, is an acute, life-threatening escalation of thyrotoxicosis that Graves' disease patients can develop, often triggered by infection or stress. In this state, there is an extreme rise in metabolic rate and sympathetic activity, leading to high fever as the body generates and struggles to dissipate excess heat. Tachycardia, sweating, agitation, and GI symptoms can also occur, reflecting the severe hypermetabolic and hyperadrenergic state.

Among the options, fever fits this picture best because it signals the body’s overwhelmed heat-production system in a thyroid storm. Pallor is not typical, bradycardia would contradict the common fast heart rate of thyrotoxic crisis, and weight gain is contrary to the weight loss usually seen with thyrotoxicosis. Fever is the hallmark sign in this acute context.