Purpose: Papillary thyroid microcarcinoma (PTMC) is generally associated with an excellent prognosis. Despite this, lymph node metastases (LNM) are not uncommon which may influence decision making and clinical management. This study evaluates the rates of LNM in PTMC at our centre and explores clinicopathological variables associated with the presence of LNM. Methods: One hundred twenty-one cases of PTMC that were managed at a single centre from 2013 to 2024 were retrospectively analysed. Data on clinicopathological variables, including age, gender, multifocality, tumour size, extra-thyroidal extension and lymph node status, were collected. Lymph node dissection outcomes were categorized by central and lateral lymph nodes. Results: One hundred twenty-one PTMC patients were included in this study. Lymph Node dissection was performed for 57 patients and of those, 21 (37%) had LNM. Central LNM were found in 17/57 (30%) patients undergoing central lymph node dissection (CLND) and lateral LNM were identified in 10/11 (91%) patients undergoing lateral lymph node dissection.Multifocality (77.27% vs. 48.57%, P<0.05) and microscopic extrathyroidal extension (40.91% vs. 2.86%, P<0.0005) were associated with LNM. Patients with PTMC had lower rates of gross extrathyroidal extension (0% vs. 9.16%, P<0.001) and positive surgical margins (18.18% vs. 27.89%, P<0.05) compared to patients with macrocarcinoma. Conclusion LNM are not uncommon in PTMC, despite its indolent nature. Multifocality and extrathyroidal extension were found to be associated with LNM in PTMC patients. These findings suggest that prophylactic CLND should be considered in PTMC when these risk factors are present. Further studies are needed to refine PTMC management strategies.