Total thyroidectomy for hyperthyroidism is usually curative. We report the unusual recurrence of thyrotoxicosis following a near-total thyroidectomy. The patient, a 27-year-old woman, elected to have a total thyroidectomy and began levothyroxine after the procedure. Approximately 2 years later, recurrent thyrotoxicosis was evident off levothyroxine. Vascularized thyroid tissue was noted on ultrasound, and a radioactive iodine scan indicated increased uptake in the right thyroid region. She began antithyroid medication and was subsequently treated with radioactive iodine once a euthyroid state was achieved. We discuss the implications of this rare scenario-recurrence of thyrotoxicosis after near-total thyroidectomy.