Background and Aims Papillary thyroid carcinoma (PTC) is the most prevalent pathological type among thyroid cancers, and lateral neck lymph node metastasis (LLNM) in PTC is the primary cause of patient recurrence and reoperation. Therefore, this study was conducted to analyze the clinical characteristics of PTC patients, explore the influencing factors for LLNM, and construct a clinical prediction model to provide a reference basis for determining an appropriate surgical scope.Methods The clinical data of patients with PTC who underwent surgical treatment at the First Affiliated Hospital of Jinzhou Medical University from March 2018 to January 2022 were retrospectively analyzed. The clinicopathologic factors between patients who experienced LLNM and those who did not were compared. Factors that showed statistical significance were included in a multiple Logistic regression analysis. Using R 4.1.3, a predictive nomogram model for LLNM risk in PTC patients was established, and a calibration curve was plotted to evaluate the accuracy of the model. The diagnostic cut-off values for independent risk factors for LLNM were determined using the ROC curve.Results A total of 597 PTC patients were included, and 187 cases (31.32%) had LLNM. Univariate analysis showed that age, tumor diameter, multifocal lesions, extrathyroidal invasion, central neck lymph node metastasis (CLNM), and BRAF^V600E gene mutation were significant factors influencing LLNM in PTC patients (all P<0.05). Age, tumor diameter, extrathyroidal invasion, presence of CLNM and BRAF^V600E gene mutation were identified as independent risk factors for LLNM (all P<0.05). Based on these factors, a predictive nomogram model for LLNM risk in PTC patients was constructed. The nomogram demonstrated that tumor diameter had the greatest impact on LLNM, while multifocal lesions had the least. Calibration curve analysis indicated that the nomogram model had a close fit to the ideal curve for predicting LLNM in PTC patients. According to the ROC curve analysis, the diagnostic cut-off value for tumor diameter as an independent risk factor for LLNM was 1.05 cm, and the cut-off value for age was 32.5 years.Conclusion PTC patients who have factors such as younger age, tumor diameter >1.05 cm, extrathyroidal extension, presence of CLNM, and BRAF^V600E gene mutation have a relatively higher risk of developing LLNM. The nomogram model constructed based on these factors demonstrates good calibration for predicting LLNM in PTC patients. When PTC patients exhibit these characteristics and have high nomogram scores, a more cautious approach should be taken in the preoperative assessment and intraoperative exploration of their lateral neck lymph nodes, and appropriate treatment measures should be implemented to improve their prognosis.