Hyperthyroidism is common, affecting up to 3% of the population. The major causes in the UK are autoimmune (Graves hyperthyroidism) and toxic nodular goitre. Despite the prevalence of hyperthyroidism, there is relatively little agreement regarding the relative roles of the three principle treatment options antithyroid drugs, radioiodine and surgery. The presentation will address these roles and specifically will address areas of controversy regarding treatment through the use of clinical scenarios. These will include the young female patient with Graves hyperthyroidism pros and cons of thionamide therapy. The next scenario is the elderly male with known cardiovascular disease and AF how best to use radioiodine. The 3rd scenario will address the role of radioiodine in the patient with ophthalmopathy, the 4th a patient with hyperthyroidism in early pregnancy, and finally the teenage patient with Graves hyperthyroidism. These scenarios will be used to assimilate evidence regarding best practice in these relatively common clinical situations.