Purpose: Papillary thyroid microcarcinoma (PTMC) is an increasingly common diagnosis and associated with an overall excellent prognosis. As a result, there have been calls for de-escalation of PTMC postoperative surveillance. It is also recognised, however, that some patients with PTMC develop locoregional and metastatic disease or recurrence following surgical intervention, suggesting PTMC may represent a more diverse cohort of patients requiring different follow up strategies. This study aimed to assess recurrence rates in a Western Australian cohort of patients with incidental PTMC and identify potential risk factors for recurrence to help guide local practice. Methodology: A retrospective analysis was conducted of all patients with an incidental histopathological diagnosis of PTMC after undergoing thyroid surgery for a benign indication at public hospitals in Western Australia over a 10-year period (2013-2023). Data collected included potential risk factors for recurrence (age, sex, indication for operation, lymphovascular invasion, lymph node metastasis, tumour size, multifocality, thyroiditis, tumour location, extrathyroidal extension, tall cell variant, BRAF mutation) as well as outcome variables (locoregional recurrence, distant recurrence, survival). Results: Data were collected from 182 patients. Only 1 patient had locoregional recurrence of PTMC 14 months after the index operation. Potential risk factors for recurrence present in this patient included male sex, >5mm tumour, multifocality, positive BRAF mutation and lymph node metastasis identified at the index operation. However, all other patients with these potential risk factors did not develop recurrence. Conclusion: Findings from this study confirm that incidental PTMC has an excellent prognosis in the Western Australian population with very low rates of recurrence despite the presence of potential risk factors. This suggests that incidental PTMC does not require routine postoperative surveillance.