Introduction: 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 which may be associated with their presence. Methods: One-hundred-and-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 for Central and Lateral Lymph Nodes. Results: Of the 121 PTMC patients 57 had Lymph Nodes dissected and 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 (LLND) and in 10/121 (8.26%) of all PTMC patients. Multifocality (77.27% v 48.57%, p<0.05) and microscopic extrathyroidal extension (40.91% v 2.86%, p<0.0005) were associated with LNM. Patients with PTMC had lower rates of gross extrathyroidal extension (0% v 9.16%, p<0.001) and positive surgical margins (18.18% v 27.89%, pp<0.05) compared to patients with macrocarcinoma. Conclusions: Lymph node metastases are not uncommon in PTMC, despite its indolent nature. Multifocality and extrathyroidal extension are risk factors for development of LNM. 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.