In toxic nodular goiter, surgery is possible after the patient becomes euthyroid. Antithyroid drugs are used to achieve this state. Preoperative management of hyperthyroidism is sometimes very troublesome as some complications may be observed with the use of antithyroid drugs. One of the most dangerous adverse effects is agranulocytosis. When it occurs, cessation of the drug is necessary; and use of granulocyte colony-stimulating factor (G-CSF) may be effective. There are not many alternatives to antithyroid drugs for achieving euthyroidism. Apheresis may be a useful method in preoperative management of thyrotoxic patients in intolerance to antithyroid drugs. We report a 56 year-old woman with hyperthyroidism and antithyroid drug-induced granulocytopenia, in whom apheresis was performed before surgery.