The symptoms of Graves disease were first described more that 150 years ago; however, therapy remains controversial. Surgery was the only treatment available before the development of various drugs and radioiodine. Medication using thionamides has become the most commonly used therapy for Graves' disease in childhood. Historically, radioiodine has been avoided in children because of the presumed risk for carcinogenesis and genetic mutation. More recently, however, long-term follow-up studies have shown little support for these concerns and radioiodine has become more commonly employed. None of these main forms of therapy is without complication, and the decision to use one or the other is in part related to the patient, family, or clinician's perceived risk. None of the three forms of therapy is directed at the underlying immunologic problem, and until such a treatment is found, no consensus regarding the best way to manage these children is likely to be achieved. This review examines the benefits, complications, and rationale for using the three main forms of therapy for childhood hyperthyroidism owing to Graves' disease.