The clinical picture of sympathetic overdrive under anesthesia can be caused by many syndromes, which should be considered and excluded. Thus, the anesthetist needs a high level of suspicion and vigilance to recognize the diagnosis early and act accordingly. Emphasizing the pitfalls encountered in this exceptional case scenario, we present this rare case of a malnourished patient on antipsychotic medications facing an urgent operation concomitant with a thyroid storm, a situation that can rapidly progress to a decompensating multiorgan failure.