Objective: To investigate the clinical characteristics and the risk factors for occult central cervical lymph node metastasis in cN0 papillary thyroid microcarcinoma (PTMC). Methods: The clinical data of 372 patients with papillary thyroid carcinoma (PTC) at cN0 stage undergoing thyroidectomy plus prophylactic central neck dissection were retrospectively analyzed. Of the patients, 250 cases with PTMC (tumor diameter ≤1.0 cm) were regarded as study group and the other 122 cases with common PTC patients (tumor diameter >1.0–2.0 cm) served as control group. The clinical features and risk factors for central cervical lymph node metastasis of PTMC were analyzed by comparing the clinicopathologic and imaging data between the two groups of patients. Results: The incidence of central lymph node metastasis for study group and control group was 32.8% (82/250) and 42.6% (52/122) respectively, and the difference had no statistical significance (P>0.05). Univariate analysis showed that the central cervical lymph node metastasis in study group was significantly associated with tumor size, multifocality and extrathyroidal invasion (all P<0.05), but was unrelated to nodule ultrasound features and other factors (all P>0.05); the central cervical lymph node metastasis in control group was irrelevant to any of the analyzed factors (all P>0.05). Multivariate analysis identified that tumor size (OR=2.916, 95% CI=1.19–4.37), multifocality (OR=1.230, 95% CI=0.68–2.75) and extrathyroidal invasion (OR=1.923, 95% CI=1.06–3.70) were risk factors for central cervical lymph node metastasis of PTMC (all P<0.05). Conclusion: The incidence of central cervical lymph node metastasis in cN0 PTMC is similar to that in common PTC, and the risk factors are tumor size , multiple lesions and extrathyroidal invasion.