Graves’ disease is an autoimmune disease, characterized by goiter, hyperthyroidism, and ophthalmopathy. Many symptoms resemble typical transient childhood illnesses, and providers can miss subtle clues or attribute them to adolescent developmental aging. The variation in clinical management and lack of specific treatment guidelines for pediatric and adolescent patients requires careful consideration and partnership with affected patients and referral sources. This complex disease requires astute diagnostic reasoning in the primary care setting, ongoing patient and family support, and coordination of multidisciplinary health care providers. This case highlights adolescent Graves’ disease presentation in the primary care setting and the nurse practitioner role.