A 23-year-old Quarter Horse gelding was admitted to the hospital because of cachexia and hyperactive behavior of 1 year's duration. At admission the horse was severely emaciated, tachycardic with a grade V/VI diastolic murmur, pyrexic, polydipsic, enophthalmic, and alopecic. The right lobe of the thyroid gland was noticeably larger than typical. The horse was also hyperexcitable and had a ravenous appetite. A presumptive diagnosis of hyperthyroidism was made on the basis of clinical signs and high plasma thyroid hormone concentrations. Confirmation of the diagnosis was made on the basis of results of a triiodothyronine-suppression test. Following endocrine testing, the affected portion of the thyroid gland was removed and identified histologically as an adenoma. Return or plasma thyroid hormone concentrations to reference range values and resolution of the clinical signs of disease following hemithyroidectomy provided further conformation of the diagnosis. On the basis of finding in this horse, it appears that horses with hyperthyroidism may be successfully treated by hemithyroidectomy.