The use of highly active antiretroviral therapy (HAART) in the management and treatment of human immunodeficiency virus type 1 (HIV-1) has dramatically changed the course of the disease and improved overall survival. HAART results in significant decrease in viral load and enhancement of CD4 cells and gradual restoration of the immune system. However, a subset of patients may experience a paradoxical worsening after the initiation of HAART due to a heightened and dysregulated immune response. This phenomenon is termed immune reconstitution inflammatory syndrome (IRIS). The manifestation of Graves' disease (GD) after the introduction of HAART has been identified as IRIS manifestation in some patients. Thus, this occurrence should be suspected and further investigated in patients with HIV on antiretroviral therapy (ART) who present with symptoms consistent of hyperthyroidism to avoid overt hyperthyroidism. We report a case of IRIS associated Graves' disease. Our case adds to the very limited literature about this phenomenon.