Thyroidectomy is a definitive form of treatment for patients with hyperthyroid Graves disease particularly those who are noncompliant with or have serious side effects to the antithyroid drugs, have very large goitres, refuse 131I therapy or, have moderate to severe ophthalmopathy. The risk of perioperative thyroid storm is usually higher following an acute event such as surgery, trauma, or infection. Thus, patients with thyrotoxicosis presenting for surgery should ideally be made biochemically and clinically euthyroid before surgery in order to reduce this risk. Conventional preoperative preparation for surgery includes antithyroid drugs and iodine administration. This often takes months to render patients euthyroid. Far more rapid control of thyrotoxicosis can be achieved by the oral administration of lithium given in combination with corticosteroids, antithyroid drugs and b-blockers. We describe two such cases with successful and uneventful perioperative outcome.