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

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

Answer: (A)

Thyrotoxic crisis (thyroid storm) is a life-threatening escalation of Graves’–driven thyrotoxicosis where the body's metabolic rate is dramatically increased. A hallmark of this crisis is fever, because the immense heat production from the hypermetabolic state overwhelms the body's ability to dissipate heat. Along with fever, you typically see tachycardia, sweating, agitation or delirium, tremor, and GI symptoms. The other options don’t fit the picture: pallor and weight gain aren’t characteristic of this hypermetabolic storm, and bradycardia would contrast with the common rapid heart rate seen in thyroid storm. Fever, therefore, best reflects the acute, hypermetabolic nature of thyrotoxic crisis in Graves’ disease.