Representative experiences with surgical and medical (i.e., propylthiouracil) methods of managing juvenile thyrotoxicosis have been summarized and compared. The findings indicate that these methods are equally capable of eliminating the overt clinical manifestations of Graves' disease and that they yield approximately equal numbers of "cured" patients at the end of a 2-year period. Provided due care is taken, the risk of serious complications due to these forms of treatment also can be kept very low. While the surgical and medical regimens may be similar in the foregoing respects, they appear to differ considerably in terms of their impact on the life of the patient and his family. One involves a brief period of detailed medical supervision culminating in hospitalization for surgery with its very slight, but definite mortality risk. Thereafter apart from possible need to take a dose of thyroid daily, the patient may be considered essentially normal. By contrast, the other requires that the patient remember to take a dose of medication approximately every 8 hours for a minimum of 2 years. One of these doses may of necessity have to be taken in the middle of the night at an hour when children are normally allowed to sleep undisturbed. Medical therapy also requires that the patient remain accessible to his physician for regulation of dosage and for prompt recognition of drug toxicity, which should be suspected every time the child has a sore throat or fever. It is concluded that these requirements of medical management may in themselves constitute a significant handicap to the child and his parents. It follows that they are deserving of consideration in choosing between subtotal thyroidectomy and prolonged chemotherapy as treatment for children with Graves' disease.