We report a case of amiodarone-induced thyrotoxicosis, diagnosed with a systematic laboratory investigation in a 64-year-old patient, for haematuria. Despite the interruption of amiodarone, hyperthyroidism and a goiter occurred. Conventional therapy betablockers, antithyroid agents, prednisone, potassium perchlorate) did not result in any clinical improvement. The development of a malignant thyrotoxicosis with neurologic disturbances and acute respiratory insufficiency required mechanical ventilation and a subtotal thyroidectomy. The patient's status improved progressively and he was discharged without sequelae. The respective roles of medical therapy and thyroidectomy in amiodarone-induced thyrotoxicosis are discussed.