RAI therapy and withdrawal of antithyroid medications are two well described causes of thyroid storm in patients with Graves' disease. Thyroid crisis occurring 2, 3 and 8 days after RAI

ablation therapy has been reported in pediatric patients (age 10 to 19 yr). We report a 7.5 year old boy with Graves' Disease, whose hyperthyroidism was difficult to control medically for

2.5 years. Five days after discontinuing his methimazole in preparation for RAI uptake scan, he developed fever to 101 F and loose bowel movements. Thyroid studies revealed a markedly

elevated T4 of 42.6 ug/dl and T3 of 1679 ng/dl, and suppressed TSH12.0 ng/dl, and TSH