Most people don't realize that untreated or improperly treated toxic goiter is a lethal disease. Patients are in a hypermetabolic state and slowly waste away. In the end stages of the disease, you can close your index finger and thumb around the biceps of these patients.They waste away and then one day a breeze comes along and they are gone. They suffer from high output cardiac failure among many other disorders. Occasionally, they will suffer thyroid storm , sometimes called thyroid crisis.Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis. Thyroid storm may be the initial presentation of thyrotoxicosis in undiagnosed children, particularly in neonates. The clinical presentation includes fever, tachycardia, hypertension, and neurological and GI abnormalities. Hypertension may be followed by congestive heart failure that is associated with hypotension and shock. Because thyroid storm is almost invariably fatal if left untreated, rapid diagnosis and aggressive treatment are critical. Death can occur rapidly-even in minutes. Thyroid storm can occur before, during or after thyroid surgery. Just recently we admitted a patient with toxic goiter. We went to the ward, sat on her bed and dropped dead. Fortunately, we have a medical regimen that has drastically cut down on these issues which includes carbimazol, prednisone, iodine, inderal and lithium. In the USA, these patients are often treated with radioactive iodine but surgery is more common in the third world.