Papillary thyroid microcarcinoma (PTMC) refers to papillary thyroid carcinoma (PTC) with a diameter of ≤ 1 cm, which has an insidious origin and a high rate of metastasis in the lymph nodes of the neck. Therefore, it is easily missed and misdiagnosed. With the advent of high-frequency color Doppler ultrasound, the detection rate of PTMC has been greatly improved. PTMC is multicentric in nature and is often associated with other benign thyroid diseases such as nodular goiter and Hashimoto’s disease. The rate of other benign diseases in this group was 70.6% (24/34). The extent of thyroidectomy and the type of resection used in PTMC surgery are controversial, and recurrence of PTMC is related to the extent of thyroidectomy, with the greater the extent of resection, the lower the chance of recurrence. There is no difference in the recurrence rate between total thyroidectomy and subtotal (or near-total) thyroidectomy, and total thyroidectomy significantly decreases the quality of survival of patients. Therefore, it has been suggested that the best scope of surgery for PTMC located in the unilateral lobe is the affected lobe plus isthmus, and if cancer remains in the isthmus margin, total bilateral gland excision should be performed. Total thyroidectomy also brings certain benefits to patients such as: 1) complete removal of the lesion, reducing the recurrence rate; 2) preparation for postoperative I131 treatment, especially for those with distant metastases; 3) postoperative follow-up to detect the recurrence of thyroid cancer by measuring thyroglobulin levels; 4) reduction of medication dose by applying thyroxine replacement therapy instead of suppressive therapy, etc. Therefore, we introduce the relevant procedures in detail for those who are over 45 years old without reproductive requirements, and the patients and relatives can choose them. The extent of lymph node dissection in PTC, especially the choice of surgical approach for PTMC is more debated. Some studies have suggested that prophylactic cervical lymph node dissection is not required for PTMC without suspected enlarged metastatic lymph nodes. shen [et al. concluded that CLND increases the rate of local recurrence and that the risk of local recurrence is lower in cases without CLND. More studies have concluded that CLND is beneficial for PTMC. The rate of lymph node metastasis in differentiated thyroid cancer (DTC) is close to 70%, and in Asia, the rate of lymph node metastasis in asymptomatic PTMC is about 32%. Lee’s biopsy of 97 sentinel lymph nodes (SLN) in DTC confirmed that 327 of 385 SLNs were located in the central region and So et al. analyzed 551 PTC cases and concluded that PTMC has a high incidence of subclinical lymph node metastasis (37%) and that prophylactic central lymph node dissection (PCLND) can effectively address this problem. The problem is effectively addressed by prophylactic central lymph node dissection (PCLND). Vergez et al. concluded that PCLND should be performed even in cN0 to determine the stage of the disease and to guide subsequent treatment and follow-up, but whether it is beneficial for the disease itself is controversial. Evidence-based medical findings support the performance of CLND by an experienced operator in PTC cases.