Postoperative thyroid storm after lithium preparation.

Lithium carbonate is a known antithyroid agent that acts primarily to inhibit the release of preformed thyroid hormone. Lithium was chosen for preoperative preparation in a noncompliant patient with Graves' Disease who was not able to tolerate any other antithyroid agents. Despite excellent preoperative control, postoperative thyroid storm developed. This is the first reported case of the use of lithium for preoperative preparation. Since it is possible that surgical manipulation caused the demonstrated release of preformed hormone and subsequent postoperative storm, caution in the sole use of this agent for preoperative preparation seems warranted.