The choices available for treating Graves' disease have not changed dramatically in the last 20 years. The major shift has been a progressive diminution in the use of surgery as a first-line therapy. Refinements in the use of antithyroid drugs and the availability of potent β-adrenergic blockers have simplified medical management. However, most patients eventually receive radioiodine therapy and, of these, approximately 50% become hypothyroid. The major advances in unraveling the pathogenesis of Graves' disease have not yet improved the therapeutic armamentarium or outcome nor significantly sharpened the ability to predict which patients will stay in remission after antithyroid drug therapy.