Purpose: In 2025, the American Thyroid Association (ATA) updated guidelines for papillary thyroid cancer (PTC) (1). Within is a new recommendation against prophylactic central lymph node dissection (pCLND) for clinically node-negative tumors <4cm (cT1-2), citing concern that complication rates may outweigh known reductions in locoregional recurrence. Given the acknowledged oncologic benefit of pCLND in these guidelines, we evaluated complication rates at our high-volume center to assess whether pCLND remains safe for small, clinically node-negative PTC when performed by high-volume thyroid surgeons. Methodology: We retrospectively analyzed 400 patients with PTC measuring 1-4cm (T1b-T2) with clinically negative lymph node basins who underwent thyroidectomy with pCLND between 2018-2025. Complication rates were compared between total thyroidectomy and hemithyroidectomy. Results: 69% of patients had tumors 1-2cm and 31% had tumors 2-4cm. Total thyroidectomy was performed in 65.8%, hemithyroidectomy in 34.0%, and completion hemithyroidectomy in 0.25%. Temporary recurrent laryngeal nerve (RLN) palsy occurred in 1.5% of total thyroidectomies and 5.8% of hemithyroidectomies. No permanent RLN palsy occurred. Temporary hypocalcemia occurred in 1.1% of total thyroidectomies and in 0% of hemithyroidectomies. Permanent hypoparathyroidism occurred in 0.4% of total thyroidectomies and 0% of hemithyroidectomies. Conclusions: pCLND performed by high-volume thyroid surgeons is associated with low complication rates. The low temporary hypocalcemia rate observed may reflect routine postoperative oral calcium supplementation. pCLND appears safe for T2 and smaller PTC with experienced hands, offering oncologic benefit with low perioperative risk. Locoregional recurrence analysis is ongoing in this cohort. References: (1) Ringel MD, et al. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841–985.