Introduction: Amiodarone induced thyrotoxicosis (AIT) is a challenging condition to treat due to long half-life of amiodarone and resistance to medical therapy. Plasmapheresis is a therapeutic option in patients requiring urgent thyroidectomy. Case Description: A 68-year old male presented with diarrhoea, weight loss and fevers on a background of atrial fibrillation on Amiodarone for 2 years. Exam revealed tachycardia and fevers, without a palpable goitre or eye signs. Bloods demonstrated deranged liver functions and thyrotoxicosis (Free T4 >100 pmol/L) with negative TSH-receptor antibodies. A CT-scan of the abdomen demonstrated a 10.7cm lesion the left lobe of the liver suspicious for a ruptured hepatocellular carcinoma (HCC) needing a left hemi-hepatectomy. Ultrasound demonstrated mildly enlarged thyroid without nodules, diagnosed as Type 2 AIT. He developed worsening features of thyrotoxicosis with minimal response to medical therapy. He underwent 3 days of plasmapheresis as a bridge to total thyroidectomy and uncomplicated recovery. Histology was consistent with diagnosis of Type 2 AIT. A hemi-hepatectomy 2 weeks later demonstrating a moderately differentiated HCC. Discussion: AIT can exacerbate underlying cardiac anomalies and is associated with an increased risk of morbidity and mortality. Although initial recommendations are trial of conventional therapy, severe cases or those requiring urgent procedures can benefit from timely plasmapheresis as a bridging therapy to salvage thyroidectomy. The timing of response, number of plasma exchanges required and complications can be variable. Futher studies need to look at the timing of initiation, type of replacement fluid and number of exchanges required before surgery.