Based on the regular lymph node metastasis rule of malignant tumors and the lymph node metastasis characteristics of thyroid cancer, we believe that patients with primary tumor invading the perineum, primary tumor I>2 cm and lymph node metastasis in area VI are prone to lateral cervical lymph node metastasis. In addition, patients with enlarged lymph nodes in area III and/or IV on preoperative ultrasound examination but not considered to have metastasis are also considered to be at high risk for cervical lymph node metastasis due to the limitations of ultrasound techniques and machines. Patients with metastatic lymph nodes in region VI are significantly more likely to develop lateral cervical lymph node metastasis than patients without metastatic cancer. Therefore, lymph node dissection in the III and IV regions of the neck is of great significance for cN0 patients with high-risk thyroid cancer in the neck, especially for patients with lymph node metastasis in region VI and thyroid perineural invasion, which can promptly detect and remove occult metastasis in the lateral cervical lymph nodes and, in a certain sense, prolong patients’ survival time and improve their quality of life. Especially for young patients, once lymph node metastasis in zones III and IV is detected, total cervical lymph node dissection should be completed, and at least zone II-IV lymph node dissection should be completed. In conclusion, for patients with high-risk cN0 thyroid cancer in the neck, performing lymph node dissection in zones III and IV of the neck is clinically important to timely detect and remove metastasis of occult lymph nodes in the lateral neck, prolong the survival time of patients and improve their quality of life. It is recommended to routinely perform lymph node dissection in the III and IV regions of the neck in cN0 patients with thyroid cancer with perineural invasion and lymph node metastasis in region VI.