Background: Thyroid cancer is the most common carcinoma in children, and compared with adults, generally present with more advanced disease. Management is similar between populations, primarily consisting of total thyroidectomy. With similar treatment despite disease severity, we chose to explore the surgical outcome of pediatric patients with thyroid malignancy. Methods: A review of medical records at two academic institutions revealed 68 patients < 19 y of age who underwent surgical resection of a malignant thyroid nodule between 1962 and 2008. Results: Of 68 pediatric surgery patients identified with thyroid malignancy, 50 patients (74%) had a total thyroidectomy. Minor complications were noted in 21% of surgeries with 19% temporary hypocalcemia. Risk of complication was not associated with type of surgery. Patients receiving a lobectomy or subtotal thyroidectomy were at greater risk for needing a second surgical procedure, required by 14 patients (21%). Conclusions: There was no significant increase in surgical complications with respect to type of surgery, however, patients receiving less than total thyroidectomy were at increased risk of repeat surgery. Total thyroidectomy is recommended as the standard of care for the management of pediatric thyroid cancer. © 2009 Elsevier Inc. All rights reserved.