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In pediatric Graves’ disease, operative morbidity after total thyroidectomy remains ill defined. The present study aimed to clarify whether total thyroidectomy entails greater operative morbidity in children with Graves’ disease, in particular when they are very young, as compared with an age-matched reference group of children with hereditary C-cell disease who underwent total thyroidectomy at the same time.Operative morbidity after total thyroidectomy for Graves’ disease was determined in relation to the child's age and in comparison with a reference group of age-matched children with hereditary C-cell disease.Included in the study were 58 children with Graves’ disease (51 girls and 7 boys) and 108 children with hereditary C-cell disease (59 girls and 49 boys). When children with Graves’ disease and children with hereditary C-cell disease were compared across and within the 4 age increments (≤ 3, 4–6, 7–12, and 13–18 years), operative mortality did not differ significantly among and within age increments. Children with Graves’ disease had a 1.7-fold greater overall risk of transient hypoparathyroidism (29% versus 17%; P = .073) than children with hereditary C-cell disease. Permanent hypoparathyroidism was nil in either group. Transient recurrent laryngeal nerve palsy, wound hemorrhage, and wound infections were infrequent (≤ 3% each), resolving spontaneously and after reoperation, respectively.Disease impacts more than age on operative morbidity in children with Graves’ disease after total thyroidectomy but is fairly low overall and rarely permanent in experienced hands.