Background The utilization of thyroidectomy for Graves’ disease remains controversial; we aim to evaluate the indications for and complications of thyroidectomy for Graves’ in children. Methods A retrospective analysis was performed on all Graves’ patients who underwent thyroidectomy from 2009 to 2013 at a high volume academic center. Pediatric patients were < 18 years old, and a comparative analysis of indications for surgery and complications was performed. Results 167 patients underwent thyroidectomy: 31 pediatric patients and 136 adults. Failure of antithyroid medications was the indication for surgery in 55% of the children vs 36% of adults (p = 0.05). Mean duration of medications prior to surgery was similar. No children had failed RAI therapy prior to surgery, but 12.5% of the adult population had (p = 0.04). Surgical outcomes were similar. Conclusion Clinicians may be more likely to refer children who fail medical treatment to surgery over RAI. Thyroidectomy at a high volume hospital should be discussed as a treatment option for children with Graves’.