Objective: To analyze the clinical and pathological features of thyroid microcarcinoma and assess the value of total thyroidectomy in the treatment of this condition. Methods: The medical records of 128 patients with thyroid microcarcinoma confirmed by surgical and pathological findings from October 2009 to December 2012 were retrospectively analyzed. All patients underwent total thyroidectomy and some of them also received adjuvant 131I therapy. Results: Of the 128 patients, single focus of microcarcinoma was found in 87 cases (67.97%), and multiple foci of microcarcinoma were found in 41 cases of (32.03%). The diameters of lesions in patients with single focus of microcarcinoma were all larger than 0.3 cm and were able to be detected by preoperative ultrasound; among patients with multiple foci of microcarcinoma, all of the lesions in 25 cases (60.98%) were clearly identified by preoperative ultrasound, while in the other 16 cases (39.03%), preoperative ultrasound could detect those lesions that were larger than 0.3 cm and the other lesions were found by intraoperative frozen section or postoperative paraffin sections. The multiple lesions in 22 patients (53.66%) were confined to only one side of the thyroid gland and 19 cases (43.34%) involved both sides. Postoperative follow-up rate was 100%, and one patient developed cervical lymph node metastases. Conclusion: Better understanding of the clinical and pathological characteristics of thyroid microcarcinoma, along with extensive examination may avoid missed diagnosis; total thyroidectomy is of proven value in treatment of thyroid microcarcinoma.