Aim and background: Papillary thyroid carcinoma (PTC) is not uncommon in nodules associated with Graves’ disease (GD). We intend to assess the likelihood of malignancy in GD especially in those without discrete nodules in a tertiary care center. Materials and methods: Data collected from the Department of Endocrine Surgery of all GD patients who underwent total thyroidectomy at Madras Medical College between August 2022 and August 2023 were retrospectively analyzed from a prospective database. Based on histopathology, these GD patients were subdivided into malignant (group A) and non-malignant (group B) and analyzed based on various parameters. Results: Eight of 35 patients who underwent total thyroidectomy for GD had PTC of which 5 were female. About 7/8 (87.5%) patients had no radiological nodules and the mean tumor size was 0.83 cm. And 7/35 patients had nodules, with 1 diagnosed with PTC on histopathology. Majority of the FNAC from these nodules were Bethesda 2 and one was Bethesda 3. About 25% of group A cases showed macrocalcifications and 12.5% showed microcalcification. There was no aggressive histology or lymph nodal metastases. Mean FT4, mean FT3, mean TSH in group A and group B were 3.1 ± 1.35 vs 2.6 ± 1.02, 10.9 ± 3.4 vs 8.5 ± 1.7, 0.2 ± 0.4 vs 0.3 ± 0.53, respectively and FT3 was significantly high in group A. Conclusion: Graves’ disease has a strong association with PTC even without sonological nodules. Except for significantly high free T3 levels we could not find any other predictive factors. Clinical significance: Graves’ disease reported higher incidence of malignancy even without any suspicious preoperative pointers. This may tilt the pendulum toward surgery as definitive strategy.