Objective: To investigate the clinicopathologic features of multifocal papillary thyroid microcarcinoma (PTMC) and the significance of prophylactic central neck dissection. Methods: The clinical data of 270 PTMC patients treated in the Department of Thyroid Surgery, Xiangya Hospital from July 2013 to December 2016 were reviewed. The differences in clinicopathologic factors between patients with multifocal PTMC and unifocal PTMC were compared, and the risk factors for central lymph node metastasis of multifocal PTMC were determined. Results: Among the 270 PTMC patients, multifocal PTMC was found in 120 cases (44.4%). In patients with multifocal PTMC, the proportion of male cases and the incidences of central lymph node metastasis and capsular invasion were significantly increased compared with patients with unifocal PTMC (both P<0.05). In multifocal PTMC patients, the maximum tumor diameter (5–10 mm vs.<5 mm), and the presence or absence of capsular invasion had significant impact on incidence of central lymph node metastasis (both P<0.05), while the lesion number (2 vs. ≥3) and distribution (unilateral lesion vs. bilateral lesion) showed no significant influence on incidence of central lymph nodes metastasis (both P>0.05). Conclusion: Compared to unifocal PTMC, multifocal PTMC has relatively poor clinicopathologic features and an increased risk of central lymph node metastasis. Prophylactic central lymph node dissection is necessary for multifocal PTMC patients, especially for those who have relatively large tumors and tumors with capsular invasion.