Angiogenesis is the mechanism of blood vessel formation after the first few days of embryogenesis, and is essential for all tissue growth. In adults, angiogenesis occurs in the thyroid during disease processes including goitre, Graves' disease, thyroiditis and cancer. The molecular mechanisms controlling angiogenesis are becoming clearer, and therapy targeting these processes is coming closer to clinical fruition. Both promoters and inhibitors of angiogenesis have been identified in the thyroid, including vascular endothelial growth factor (VEGF), fibroblast growth factor, and thrombospondin. This commentary will review the understanding of the control of angiogenesis within the context of the thyroid gland, and review the pre-eminent role of VEGF as the angiogenic signal from the follicular cells to the endothelial cells.