The extent of thyroid surgery in children and adolescents remains a matter of controversy in literature. An optimal surgical management combines good therapeutic results with low morbidity and good postoperative quality of life. In this study, the surgical treatment of benign and malignant thyroid diseases in children and adolescents was evaluated analyzing the data of 159 patients who underwent 167 surgeries in the Department of Surgery of the University Halle-Wittenberg. It could be shown that thyroid surgery can be performed with low complication rates in a specialized, high operative volume hospital. Early postoperative hypoparathyroidism occurred in 23% and permanent hypoparathyroidism in 7% of the surgeries. In univariate analysis, total thyroidectomy, systematic lymph node dissection and cancer surgery could be identified as risk factor for early postoperative hypoparathyroidism. Risk factors for permanent hypoparathyroidism were systematic lymph node dissection, cancer surgery and surgical treatment of Graves’ disease. While transient palsy of the recurrent laryngeal nerve occurred in about 2% of the nerves at risk, a permanent harm to the nerves could be prevented by a delicate surgical technique. Postoperatively, the time for convalescence in general was short ( Therapeutic results of this study indicate that total thyroidectomy with systematic lymph node dissection decreases the number of relapses in patients with thyroid carcinoma. Therefore, a radical surgical approach seems to be justified despite slightly increased complication rates. In asymptomatic carriers of a RET mutation, the optimal time for surgery can be set combining a genotype and age related approach with adjuvant calcitonin screening.